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Weng Y, Miao B, Hong D, Zhang M, Wang B, Zhao Q, Wang H. Effects of pharmacist-led interventions on glycaemic control, adherence, disease management and health-related quality of life in patients with type 2 diabetes: a protocol for a network meta-analysis. BMJ Open 2023; 13:e072960. [PMID: 37898486 PMCID: PMC10619031 DOI: 10.1136/bmjopen-2023-072960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 10/10/2023] [Indexed: 10/30/2023] Open
Abstract
INTRODUCTION The increase in the number of patients with uncontrolled type 2 diabetes mellitus (T2DM) is in need of effective management interventions. However, research to date has been limited to the evaluation of the outcomes of community pharmacists alone. Therefore, the aim of the study protocol is to compare the effects of clinical pharmacist-led intervention strategies for the management of T2DM in the outpatient settings. METHOD AND ANALYSIS The study will collect and analyse data applying standard Cochrane methodological procedures. A search for eligible studies and ongoing trials will be conducted using PubMed, Embase, Medline (via Ovid), EBSCO (via Ovid), Lippincott Williams & Wilkins (LWW) Journals (via Ovid), ProQuest Health and Medical Complete, and ClinicalTrials.gov (clinicaltrials.gov) from database inception to December 2023. Clinical and health outcomes will be measured using both glycaemic control related indicators (eg, glycated haemoglobin, fasting blood glucose, postprandial glucose) and general indicators (eg, adherence, disease management and health-related quality of life). The meta-analysis will conduct pairwise meta-analysis using random effects models and network meta-analysis (NMA) employing the Bayesian hierarchical model. The visualisation and statistical analysis will be carried out using RevMan, R Studio and ADDIS. Additionally, we will evaluate the certainty of the evidence by using Grading of Recommendations Assessment, Development and Evaluation system. ETHICS AND DISSEMINATION There will be no primary data collection from NMA participants, and there is no requirement for formal ethical review. Our aim is to present the results of this NMA in a peer-reviewed scientific journal, at conferences, and in the mainstream media. PROSPERO REGISTRATION NUMBER CRD42022355368.
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Affiliation(s)
- Yiqing Weng
- Department of Social Medicine of School of Public Health and Department of Pharmacy of the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Binghui Miao
- Department of Social Medicine of School of Public Health and Department of Pharmacy of the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Dongsheng Hong
- Department of Clinical Pharmacy, Zhejiang University School of Medicine First Affiliated Hospital, Hangzhou, China
- Zhejiang Provincial Key Laboratory for Drug Evaluation and Clinical Research, Zhejiang University School of Medicine First Affiliated Hospital, Hangzhou, China
| | - Mengdie Zhang
- Department of Social Medicine of School of Public Health and Department of Pharmacy of the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Beijia Wang
- Department of Social Medicine of School of Public Health and Department of Pharmacy of the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Qingwei Zhao
- Department of Clinical Pharmacy, Zhejiang University School of Medicine First Affiliated Hospital, Hangzhou, China
- Zhejiang Provincial Key Laboratory for Drug Evaluation and Clinical Research, Zhejiang University School of Medicine First Affiliated Hospital, Hangzhou, China
| | - Hongmei Wang
- Department of Social Medicine of School of Public Health and Department of Pharmacy of the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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López-Cobo I, Rodriguez-Latre L, Cunillera O, Ruiz I, Copetti S, Albareda M, Vila L. Trends in glycemic control, cardiovascular risk factors and chronic complications of type 2 diabetes, 2012-2016, in a healthcare area of Barcelona. Diabetes Res Clin Pract 2022; 190:110014. [PMID: 35870572 DOI: 10.1016/j.diabres.2022.110014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 06/23/2022] [Accepted: 07/18/2022] [Indexed: 01/04/2023]
Abstract
AIMS This study aimed to analyse the evolution of the metabolic control, cardiovascular risk factors and chronic complications in a Type 2 Diabetes (T2D) population in a healthcare area of Barcelona. METHODS We carried out a comparative study of T2D patients (20.457) between 2012 and 2016 (data recorded in the "Electronic Clinical-Station in Primary Care") concerning: age, gender, body mass index (BMI), arterial blood pressure (BP), HbA1c, LDL-Cholesterol, smoking, heart failure (HF), micro and macrovascular complications. RESULTS Average HbA1c was 6.9 % in 2012 and 7 % in 2016 (Non significant differences)(NS). In 2012, 57.9 % of patients presented proper glycaemic control, 42.8 % LDL-Cholesterol < 100 mg/dL and 76.9 % BP < 140/90 while in 2016 it was 61.2 % (NS), 59.2 % (p = 0.001) and 82.9 % (p = 0.016) respectively. No changes were found in BMI or active smoking. Significant increases were found in the prevalence of microvascular complications, HF and peripheral vasculopathy (PV). Patients with vascular diseases (PVD) and adequate metabolic control increased from 57.5 % to 62.7 % (p = 0.006). Albuminuria > 30 mg/g were more frequent among PVD. CONCLUSIONS Between 2012 and 2016 it was observed that, amongst our study population, glycaemic control was steady and cholesterol and BP levels were improved, while there was a significant increase of diabetic complications, HF and PV.
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Affiliation(s)
- Irela López-Cobo
- Servei d'Endocrinologia i Nutrició, Complex Hospitalari Moisès Broggi, c/Oriol Martorell, 12 -08970- Sant Joan Despí, Barcelona, Spain
| | - Lluïsa Rodriguez-Latre
- Servei d'Atenció Primària Baix Llobregat Centre, Direcció d'Atenció Primària, Costa de Ponent, Institut Català de la Salut, c/ Bellaterra, 41 -08940- Cornellà de Llobregat, Barcelona, Spain
| | - Oriol Cunillera
- Unitat de Suport a la Recerca Costa de Ponent, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), c/ Bellaterra, 41, Cornellà de Llobregat - 08940- Cornellà, Barcelona, Spain; Universitat Autònoma de Barcelona, Campus Bellaterra, - 08193 - Cerdanyola del Vallés, Barcelona, Spain
| | - Irene Ruiz
- Centre d'Atenció Primària Torrassa, Consorci Sanitari Integral, Rda. la Torrassa, 151-153, - 08903 - L'Hospitalet de Llobregat, Barcelona, Spain
| | - Silvia Copetti
- Servei d'Atenció Primària Baix Llobregat Centre, Direcció d'Atenció Primària, Costa de Ponent, Institut Català de la Salut, c/ Bellaterra, 41 -08940- Cornellà de Llobregat, Barcelona, Spain
| | - Mercè Albareda
- Servei d'Endocrinologia i Nutrició, Complex Hospitalari Moisès Broggi, c/Oriol Martorell, 12 -08970- Sant Joan Despí, Barcelona, Spain
| | - Lluís Vila
- Servei d'Endocrinologia i Nutrició, Complex Hospitalari Moisès Broggi, c/Oriol Martorell, 12 -08970- Sant Joan Despí, Barcelona, Spain.
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Lo ZJ, Chandrasekar S, Yong E, Hong Q, Zhang L, Chong LRC, Tan G, Chan YM, Koo HY, Chew T, Sani NF, Cheong KY, Cheng LRQ, Tan AHM, Muthuveerappa S, Lai TP, Goh CC, Ang GY, Zhu Z, Hoi WH, Lin JHX, Chew DEK, Lim B, Yeo PS, Liew H. Clinical and economic outcomes of a multidisciplinary team approach in a lower extremity amputation prevention programme for diabetic foot ulcer care in an Asian population: A case-control study. Int Wound J 2022; 19:765-773. [PMID: 34363329 PMCID: PMC9013583 DOI: 10.1111/iwj.13672] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 07/28/2021] [Accepted: 07/28/2021] [Indexed: 12/28/2022] Open
Abstract
Present guidelines recommend a multidisciplinary team (MDT) approach to diabetic foot ulcer (DFU) care, but relevant data from Asia are lacking. We aim to evaluate the clinical and economic outcomes of an MDT approach in a lower extremity amputation prevention programme (LEAPP) for DFU care in an Asian population. We performed a case-control study of 84 patients with DFU between January 2017 and October 2017 (retrospective control) vs 117 patients with DFU between December 2017 and July 2018 (prospective LEAPP cohort). Comparing the clinical outcomes between the retrospective cohort and the LEAPP cohort, there was a significant decrease in mean time from referral to index clinic visit (38.6 vs 9.5 days, P < .001), increase in outpatient podiatry follow-up (33% vs 76%, P < .001), decrease in 1-year minor amputation rate (14% vs 3%, P = .007), and decrease in 1-year major amputation rate (9% vs 3%, P = .05). Simulation of cost avoidance demonstrated an annualised cost avoidance of USD $1.86m (SGD $2.5m) for patients within the LEAPP cohort. In conclusion, similar to the data from Western societies, an MDT approach in an Asian population, via a LEAPP for patients with DFU, demonstrated a significant reduction in minor and major amputation rates, with annualised cost avoidance of USD $1.86m.
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Affiliation(s)
- Zhiwen Joseph Lo
- Vascular Surgery Service, Department of General SurgeryTan Tock Seng HospitalSingapore
- Lee Kong Chian School of Medicine Centre for Population Health SciencesNayang Technological UniversitySingapore
- Skin Research Institute of SingaporeAgency for Science, Technology and ResearchSingapore
| | - Sadhana Chandrasekar
- Vascular Surgery Service, Department of General SurgeryTan Tock Seng HospitalSingapore
| | - Enming Yong
- Vascular Surgery Service, Department of General SurgeryTan Tock Seng HospitalSingapore
| | - Qiantai Hong
- Vascular Surgery Service, Department of General SurgeryTan Tock Seng HospitalSingapore
| | - Li Zhang
- Vascular Surgery Service, Department of General SurgeryTan Tock Seng HospitalSingapore
| | | | - Glenn Tan
- Vascular Surgery Service, Department of General SurgeryTan Tock Seng HospitalSingapore
| | - Yam Meng Chan
- Vascular Surgery Service, Department of General SurgeryTan Tock Seng HospitalSingapore
| | - Hui Yan Koo
- Vascular Surgery Service, Department of General SurgeryTan Tock Seng HospitalSingapore
| | - Tiffany Chew
- Department of PodiatryTan Tock Seng HospitalSingapore
| | | | | | | | | | | | - Tina Peiting Lai
- Wound and Stoma Care, Nursing SpecialtyTan Tock Seng HospitalSingapore
| | - Cheng Cheng Goh
- Wound and Stoma Care, Nursing SpecialtyTan Tock Seng HospitalSingapore
| | - Gary Y. Ang
- Health Services and Outcomes ResearchNational Healthcare GroupSingapore
| | - Zhecheng Zhu
- Health Services and Outcomes ResearchNational Healthcare GroupSingapore
| | - Wai Han Hoi
- Department of EndocrinologyWoodlands Health CampusSingapore
| | | | | | - Brenda Lim
- Department of EndocrinologyTan Tock Seng HospitalSingapore
| | - Pei Shan Yeo
- Department of EndocrinologyTan Tock Seng HospitalSingapore
| | - Huiling Liew
- Department of EndocrinologyTan Tock Seng HospitalSingapore
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Variability in the Control of Type 2 Diabetes in Primary Care and Its Association with Hospital Admissions for Vascular Events. The APNA Study. J Clin Med 2021; 10:jcm10245854. [PMID: 34945149 PMCID: PMC8703537 DOI: 10.3390/jcm10245854] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 12/02/2021] [Accepted: 12/08/2021] [Indexed: 01/14/2023] Open
Abstract
Type 2 diabetes (T2D) is associated with increased cardiovascular morbidity, mortality, and hospital admissions. This study aimed to analyze how the differences in delivered care (variability of glycosylated hemoglobin (HbA1c) achieved targets) affect hospital admissions for cardiovascular events (CVEs) in T2D patients. Methods: We analyzed the electronic records in primary care health centers at Navarra (Spain) and hospital admission for CVEs. We followed 26,435 patients with T2D from 2012 to 2016. The variables collected were age, sex, health center, general practitioner practice (GPP), and income. The clinical variables were diagnosis of T2D, weight, height, body mass index (BMI), blood pressure (BP), HbA1c, low-density lipoprotein cholesterol (LDL-C), smoking, and antecedents of CVEs. We calculated, in each GPP practice, the proportion of patients with HbA1c ≥ 9. A non-hierarchical K-means cluster analysis classified GPPs into two clusters according to the level of compliance with HbA1C ≥ 9% control indicators. We used logistic and Cox regressions. Results: T2D patients had a higher probability of admission for CVEs when they belonged to a GPP in the worst control cluster of HbA1C ≥ 9% (HR = 1.151; 95% CI, 1.032–1.284).
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Sánchez-Hernández MS, Rodríguez-Caldero MC, Martín-Pérez MP, Mira-Solves JJ, Vitaller-Burillo J, Carratalá-Munuera MC. Impact of adherence to Mediterranean diet and/or drug treatment on glycaemic control in type 2 diabetes mellitus patients: DM2-CUMCYL study. Prim Care Diabetes 2020; 14:685-691. [PMID: 32674912 DOI: 10.1016/j.pcd.2020.06.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 06/26/2020] [Accepted: 06/27/2020] [Indexed: 01/14/2023]
Abstract
AIMS This study aimed to analyse the association between adherence to treatment and glycaemic control in people with type 2 diabetes mellitus. METHODS Multicentre, cross-sectional study in patients with type 2 diabetes mellitus recruited by primary care professionals in Castilla y León (Spain). Sociodemographic and clinical characteristics were reflected in self-reported questionnaire, which included the Morisky-Green Medication Adherence Scale and the 14-point Mediterranean Diet Adherence Screener. Medication non-adherence and poor glycaemic control were analysed by bivariable and multivariable analyses. RESULTS Of 3536 included patients, the 33.8% reported non-adherence to pharmacological treatment, and the 33.7% had poor glycaemic control (HbA1c ≥58 mmol/mol [7.5%]); 50.6% of patients reported moderate-high adherence to the Mediterranean diet (≥9 points). The multivariable logistic regression model showed that educational level (OR 0.73; 95% CI 0.61-0.87; p < 0.001) and sedentarism (OR 1.64; 95% CI 1.36-1.98; p < 0.001) were associate with low adherence. Younger age, rural residence, smoking, time since diagnosis (OR 1.04; 95% CI 1.03-1.05; p < 0.001) and polypharmacy were associated with poor glycaemic control. CONCLUSION Lower educational level and sedentarism were associated with low adherence. Younger age, rural residence, smoking, time since diagnosis and polypharmacy, increased risk of poor glycaemic control.
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Affiliation(s)
- María Sonsoles Sánchez-Hernández
- Health Psychology Department, Miguel Hernández University, Avda de la Universidad s/n Edificio Altamira, 03202 Elche, Alicante, Spain.
| | | | | | - Jose Joaquín Mira-Solves
- Health Psychology Department, Miguel Hernández University, Avda de la Universidad s/n Edificio Altamira, 03202 Elche, Alicante, Spain
| | - Julian Vitaller-Burillo
- Department of Public Health, History Science and Gynaecology, Miguel Hernández University, Crta. Nacional, N-332, s/n, 03550 Sant Joan, Alicante, Spain
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Pousinho S, Morgado M, Plácido AI, Roque F, Falcão A, Alves G. Clinical pharmacists´ interventions in the management of type 2 diabetes mellitus: a systematic review. Pharm Pract (Granada) 2020; 18:2000. [PMID: 32922572 PMCID: PMC7470242 DOI: 10.18549/pharmpract.2020.3.2000] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 08/16/2020] [Indexed: 11/14/2022] Open
Abstract
Background Type 2 diabetes mellitus is a chronic disease that is reaching epidemic proportions worldwide. It is imperative to adopt an integrated strategy, which involves a close collaboration between the patient and a multidisciplinary team of which pharmacists should be integral elements. Objective This work aims to identify and summarize the main effects of interventions carried out by clinical pharmacists in the management of patients with type 2 diabetes, considering clinical, humanistic and economic outcomes. Methods PubMed and Cochrane Central Register of Controlled Trials were searched for randomized controlled trials assessing the effectiveness of such interventions compared with usual care that took place in hospitals or outpatient facilities. Results This review included 39 studies, involving a total of 5,474 participants. Beneficial effects were observed on various clinical outcomes such as glycemia, blood pressure, lipid profile, body mass index and coronary heart disease risk. For the following parameters, the range for the difference in change from baseline to final follow-up between the intervention and control groups was: HbA1c, -0.05% to -2.1%; systolic blood pressure, +3.45 mmHg to -10.6 mmHg; total cholesterol, +10.06 mg/dL to -32.48 mg/dL; body mass index, +0.6 kg/m2 to -1.94 kg/m2; and coronary heart disease risk, -3.0% and -12.0% (among the studies that used Framinghan prediction method). The effect on medication adherence and health-related quality of life was also positive. In the studies that performed an economic evaluation, the interventions proved to be economically viable. Conclusions These findings support and encourage the integration of clinical pharmacists into multidisciplinary teams, underlining their role in improving the management of type 2 diabetes.
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Affiliation(s)
- Sarah Pousinho
- MSC. CICS-UBI - Health Sciences Research Centre, University of Beira Interior. Covilhã (Portugal).
| | - Manuel Morgado
- PhD, PharmD. CICS-UBI - Health Sciences Research Centre, University of Beira Interior. Covilhã (Portugal).
| | - Ana I Plácido
- PhD. Research Unit for Inland Development, Polytechnic of Guarda (UDI-IPG). Guarda (Portugal).
| | - Fátima Roque
- PhD, PharmD. CICS-UBI - Health Sciences Research Centre, University of Beira Interior. Covilhã (Portugal).
| | - Amílcar Falcão
- PhD, PharmD. Centre for Neuroscience and Cell Biology, Laboratory of Pharmacology, Faculty of Pharmacy, University of Coimbra. Coimbra (Portugal).
| | - Gilberto Alves
- PhD, PharmD. CICS-UBI - Health Sciences Research Centre, University of Beira Interior. Covilhã (Portugal).
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Lapena C, Borràs E, Digon C, Aznar R, Del Val Garcia JL, Castelblanco E, Garaikoetxea A, Laguna V. Effectiveness of a comprehensive care protocol in patients with new diagnoses of type 2 diabetes mellitus and associated comorbidities in primary care: study protocol of a quasi-experimental trial. BMJ Open 2020; 10:e033725. [PMID: 32580980 PMCID: PMC7312326 DOI: 10.1136/bmjopen-2019-033725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 04/22/2020] [Accepted: 05/01/2020] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Type 2 diabetes mellitus (T2DM) is a highly prevalent chronic disease in the Spanish population. Typically, T2DM is associated with other chronic conditions. Intensive medication at the time of diagnosis has proven effective in reducing cardiovascular risk, improving glycaemic control and preventing T2DM complications. However, it has not yet been demonstrated that a comprehensive and intensive health education protocol at the time of diagnosis has the benefits described previously. Currently, there is great variability in the practices of primary care nurses regarding health education at the time of disease diagnosis.We aimed to evaluate the effectiveness of a systematic protocol with a comprehensive care programme in people with newly diagnosed T2DM with associated comorbidities. METHODS AND ANALYSIS A multicentre quasi-experimental design comparing a group of individuals taking part in the intervention (intervention group (IG)) with a similar group receiving standard diabetes care (comparison group (CG)) is planned. The intervention will take place during the 3 months after study enrolment. Data will be collected at baseline and at 3, 6 and 12 months. Ten primary care centres in Barcelona city will be selected for participation: 5 for the IG and 5 for the CG. The IG will include five structured individual visits postdiagnosis with the primary care nurse, during which aspects of diabetes education will be discussed with the patient and his/her family. The results will be measured in terms of health-related quality of life and the change in main outcomes (glycated haemoglobin and weight). ETHICS AND DISSEMINATION The study fully met the requirements of the Ethical Committee of Clinical Investigation of the IDIAP Jordi Gol (approval code: P13/118). Patients will be informed that their data are confidential, and they have the right to withdraw at any time without penalty. Dissemination will include publishing the findings in peer-reviewed journals and sharing our findings at scientific conferences. TRIAL REGISTRATION NUMBER NCT03990857; Pre-results.
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Affiliation(s)
- Carolina Lapena
- Centre d'Atenció Primària Sanllehy, Gerència d'Àmbit d'Atenció Primària Barcelona Ciutat, Institut Català de la Salut, Barcelona, Spain
- Unitat de Suport a la Recerca Barcelona Ciutat, Fundació Institut Universitari per a la recerca en Atenció Primària de Salut Jordi Gol i Gurina (IDIAP Jordi Gol), Barcelona, Spain
| | - Enriqueta Borràs
- Gerència Territorial de Barcelona Ciutat, Institut Català de la Salut, Barcelona, Spain
| | - Clarisa Digon
- Centre d'Atenció Primària Sagrera, Gerència d'Àmbit d'Atenció Primària Barcelona Ciutat, Institut Català de la Salut, Barcelona, Spain
| | - Rosa Aznar
- Centre d'Atenció Primària Sanllehy, Gerència d'Àmbit d'Atenció Primària Barcelona Ciutat, Institut Català de la Salut, Barcelona, Spain
| | - Jose Luis Del Val Garcia
- Unitat de Suport a la Recerca Barcelona Ciutat, Fundació Institut Universitari per a la recerca en Atenció Primària de Salut Jordi Gol i Gurina (IDIAP Jordi Gol), Barcelona, Spain
- Unidad de Evaluación, Sistemas de Información y Calidad, Institut Català de la Salut, Barcelona, Spain
| | - Esmeralda Castelblanco
- DAP-Cat Group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Department of Endocrinology and Nutrition, Hospital de la Santa Creu i Sant Pau & Institut d'Investigació Biomédica Sant Pau (IIB Sant Pau) & Centre for Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM), Barcelona, Spain
| | - Ana Garaikoetxea
- Centre d'Atenció Primària Sanllehy, Gerència d'Àmbit d'Atenció Primària Barcelona Ciutat, Institut Català de la Salut, Barcelona, Spain
| | - Vicencia Laguna
- Centre d'Atenció Primària Sanllehy, Gerència d'Àmbit d'Atenció Primària Barcelona Ciutat, Institut Català de la Salut, Barcelona, Spain
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Galbete A, Cambra K, Forga L, Baquedano FJ, Aizpuru F, Lecea O, Librero J, Ibáñez B. Achievement of cardiovascular risk factor targets according to sex and previous history of cardiovascular disease in type 2 diabetes: A population-based study. J Diabetes Complications 2019; 33:107445. [PMID: 31668588 DOI: 10.1016/j.jdiacomp.2019.107445] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 08/01/2019] [Accepted: 09/07/2019] [Indexed: 12/22/2022]
Abstract
AIMS The main objective was to assess, using real-practice primary care records, the degree of control of cardiovascular risk factor targets. Records were stratified by the presence of previous history or cardiovascular disease (CVD), and sex differences in the fulfillment profile were analyzed. METHODS This is a cross-sectional population-based study conducted in Spain. Type 2 diabetes patients over 20 years old (n = 32,638) were identified from primary care electronic health records, and the following information was extracted: glycated hemoglobin (HbA1c), systolic and diastolic blood pressure (SBP and DBP), LDL and HDL cholesterol levels, triglycerides, BMI and smoking history. RESULTS Patients with CVD had worse control of HbA1c than patients without it, (HbA1c < 7% 56.9% vs. 61.2%) but better control of BP (<130/80: 43.5% vs 38.2%) and lipids. In the group without prior CVD history, women had worse control of HbA1c, LDL, HDL, BMI and triglycerides and better control of blood pressure and smoking. These differences were maintained or accentuated in the group with previous CVD. CONCLUSIONS Women had poorer control of CV risk factors in both groups, and the sex-gap is accentuated in patients with previous CVD.
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Affiliation(s)
- Arkaitz Galbete
- Navarrabiomed-Complejo Hospitalario de Navarra-UPNA, Pamplona, Spain; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Spain.
| | - Koldo Cambra
- Instituto de Salud Pública y Laboral de Navarra, Pamplona, Spain; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Spain; IdiSNA, Pamplona, Spain.
| | - Luis Forga
- Servicio de Endocrinología y Nutrición, Complejo Hospitalario de Navarra, Servicio Navarro de Salud-Osasunbidea, Pamplona, Spain; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Spain; IdiSNA, Pamplona, Spain.
| | - Francisco Javier Baquedano
- Gerencia de Atención Primaria, Servicio Navarro de Salud-Osasunbidea, Pamplona, Spain; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Spain.
| | - Felipe Aizpuru
- Hospital de Txagorritxu, Servicio Vasco de Salud-Osakidetza, Vitoria Gasteiz, Spain; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Spain.
| | - Oscar Lecea
- Gerencia de Atención Primaria, Servicio Navarro de Salud-Osasunbidea, Pamplona, Spain.
| | - Julián Librero
- Navarrabiomed-Complejo Hospitalario de Navarra-UPNA, Pamplona, Spain; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Spain.
| | - Berta Ibáñez
- Navarrabiomed-Complejo Hospitalario de Navarra-UPNA, Pamplona, Spain; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Spain; IdiSNA, Pamplona, Spain.
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García-Molina L, Lewis-Mikhael AM, Riquelme-Gallego B, Cano-Ibáñez N, Oliveras-López MJ, Bueno-Cavanillas A. Improving type 2 diabetes mellitus glycaemic control through lifestyle modification implementing diet intervention: a systematic review and meta-analysis. Eur J Nutr 2019; 59:1313-1328. [PMID: 31781857 DOI: 10.1007/s00394-019-02147-6] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 11/18/2019] [Indexed: 12/12/2022]
Abstract
PURPOSE Type 2 diabetes mellitus represents a significant health problem. Many studies have reported that intensive nutritional intervention by itself or in addition to medications is the best method to improve glycaemic control in type 2 diabetes mellitus. However, in clinical practice, dietary education is not implemented as an integral part in the management of type 2 diabetes mellitus. The purpose of this systematic review and meta-analysis is to analyse the scientific evidence concerning the role of nutritional intervention in the glycaemic control of type 2 diabetes mellitus. METHODS We searched Pubmed, Scopus, Cochrane Library and Web of Science databases from inception till May 2019 for randomised controlled trials (RCTs) that include dietary interventions in the management of patients with type 2 diabetes mellitus. RESULTS A total of 28 studies were included. Our results demonstrated that lifestyle interventions significantly lowered glycosylated haemoglobin (HbA1c) levels compared to the usual care for patients with type 2 diabetes mellitus, overall weighted mean difference, WMD = - 0.51 (- 0.67, - 0.35). Strategies combining individualized and group-based activities were the most effective, WMD = - 0.95 (- 1.24, - 0.66). Most of stratified analyses did not totally resolve heterogeneity, but improvement in HbA1c levels has been consistently observed. CONCLUSIONS The available evidence from RCTs shows that lifestyle intervention is more effective than the standard care regarding the glycaemic control of type 2 diabetic patients, particularly when there is a weight loss. It is time to translate this evidence to the primary health care practice. The protocol of the present systematic review was registered in PROSPERO, registration number CRD42018090469.
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Affiliation(s)
- Laura García-Molina
- Department of Preventive Medicine and Public Health, University of Granada, Avenida de la Investigación, 11, 18016, Granada, Spain.
- CIBER Epidemiología y Salud Pública (CIBERESP), Avenida Monforte de Lemos, 3-5, 28029, Madrid, Spain.
| | - Anne-Mary Lewis-Mikhael
- Department of Obstetrics and Gynecology, McMaster University, 1280 Main Street West, Hamilton, ON, Canada
- High Institute of Pubic Health, Alexandria University, 165 El-Horreya Avenue - El-Ibrahimia, Alexandria, Egypt
| | - Blanca Riquelme-Gallego
- Department of Preventive Medicine and Public Health, University of Granada, Avenida de la Investigación, 11, 18016, Granada, Spain
- Fundación para la Investigación Biosanitaria de Andalucía Oriental (FIBAO), Avenida de Madrid, 15, 18018, Granada, Spain
| | - Naomi Cano-Ibáñez
- Department of Preventive Medicine and Public Health, University of Granada, Avenida de la Investigación, 11, 18016, Granada, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Avenida Monforte de Lemos, 3-5, 28029, Madrid, Spain
| | - María-Jesús Oliveras-López
- Department of Molecular Biology and Biochemical Engineering, University Pablo de Olavide, Carretera de Utrera, Km 1, 41013, Seville, Spain
| | - Aurora Bueno-Cavanillas
- Department of Preventive Medicine and Public Health, University of Granada, Avenida de la Investigación, 11, 18016, Granada, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Avenida Monforte de Lemos, 3-5, 28029, Madrid, Spain
- Instituto de Investigación Biosanitaria de Granada (ibs.Granada), Servicio Andaluz de Salud/Universidad de Granada, Avenida de Madrid, 15, 18018, Granada, Spain
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10
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Gómez García MC, Franch-Nadal J, Millaruelo Trillo JM, Cos-Claramunt FX, Avila Lachica L, Buil Cosiales P. [Blood glucose control and cardiovascular risk factors in type 2 diabetic patients with cardiovascular disease in Spain, and its treatment pattern, according to gender: CODICE study]. Semergen 2019; 46:125-135. [PMID: 31399388 DOI: 10.1016/j.semerg.2019.05.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Revised: 05/17/2019] [Accepted: 05/27/2019] [Indexed: 01/03/2023]
Abstract
INTRODUCTION AND OBJECTIVES With the implementation of the Strategy of Health Promotion and Prevention in Spain, the scenario reflected in previous studies of low control of cardiovascular risk factors (CVRF) in patients with type 2 diabetes (DM2) and cardiovascular disease (CVD) can be modified. This study intends to determine the level of blood glucose control and other CVRF in patients with DM2 and CVD currently seen in clinics in Spain, as well as the pattern of antidiabetic treatment, and differences according to gender. MATERIALS AND METHODS An epidemiological, observational, cross-sectional, nationwide study was conducted in patients of both genders diagnosed with DM2 and established CVD. RESULTS The study included 3,143 patients with a mean age 69.0±10 years. The mean HbA1c was 7.4±1.1% in females vs 7.3±1.2% in males (P<.05) and systolic blood pressure was 137±15.0mmHg in females vs 135.6±14.7mmHg in males (P<.05). The mean LDL-cholesterol was 101.5±38.1mg/dl in females vs 91.1±37.5mg/dl in males; P<.001) and the mean body mass index (30.7±5.4kg/m2 in females vs 29.6±4.5kg/m2 in males; P<.001). The most used treatments were metformin (68.1%) and/or DPP4 inhibitors (53.7%), with no differences between genders. CONCLUSIONS The level of blood glucose control of DM2 patients with CVD in Spain can be improved. The treatment profile does not conform to the recommendations of clinical practice guidelines in general. The differences in the control of CVRF are worse in women for lipids and obesity.
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Affiliation(s)
- M C Gómez García
- Unidad de Gestión Clínica Vélez-Norte, Vélez-Málaga, Málaga, España
| | | | | | | | - L Avila Lachica
- Unidad de Gestión Clínica Vélez-Norte, Vélez-Málaga, Málaga, España
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11
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Morgado M, Pousinho S. The effectiveness of self-care and family-oriented interventions in patients with diabetes mellitus. Fam Pract 2019; 36:375-377. [PMID: 30596997 DOI: 10.1093/fampra/cmy131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Manuel Morgado
- CICS-UBI-Health Sciences Research Centre, University of Beira Interior, Covilhã, Portugal.,Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal.,School of Health Sciences, Polytechnic Institute of Guarda, Guarda, Portugal.,Pharmaceutical Services, Centro Hospitalar Universitário Cova da Beira, Covilhã, Portugal
| | - Sarah Pousinho
- CICS-UBI-Health Sciences Research Centre, University of Beira Interior, Covilhã, Portugal
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12
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Navarro Oliver A, Martínez Navarro A, Martínez Navarro M, Leal Hernández M. Efecto a largo plazo de un programa estructurado de educación para la salud en pacientes diabéticos. Semergen 2019; 45:e22-e23. [DOI: 10.1016/j.semerg.2019.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Revised: 01/15/2019] [Accepted: 02/21/2019] [Indexed: 11/25/2022]
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13
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Basterra-Gortari FJ, Bes-Rastrollo M, Ruiz-Canela M, Gea A, Sayón-Orea C, Martínez-González MÁ. Trends of obesity prevalence among Spanish adults with diabetes, 1987-2012. Med Clin (Barc) 2019; 152:181-184. [PMID: 29703612 DOI: 10.1016/j.medcli.2018.03.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 03/20/2018] [Accepted: 03/22/2018] [Indexed: 11/18/2022]
Abstract
INTRODUCTION AND OBJECTIVE Our aim was to examine the secular trends in obesity prevalence among Spanish adults with diabetes. MATERIAL AND METHODS Data were collected from 8 waves (from 1987 to 2012) of the National Health Surveys (NHS). NHS are cross-sectional studies conducted in representative samples of the Spanish adult population. Data of 7378 adults (≥16 years) who reported having been diagnosed of diabetes were analyzed. Previously validated self-reported weight and height were used to estimate body mass index (BMI). Obesity was defined as a BMI of 30kg/m2 or greater. Age-adjusted obesity prevalence for each wave was calculated by the direct standardization method. RESULTS From 1987 to 2012 age-adjusted prevalence of obesity among persons with diabetes increased from 18.2% (95% confidence interval [CI]: 14.2-22.2%) to 39.8% (95% CI: 36.8-42.8%). Age-adjusted prevalence of obesity in males with diabetes increased from 13.2% (95% CI: 7.3-19.1%) to 38.0% (95% CI: 33.8-42.1%) and in females from 23.0% (95% CI: 17.6-28.4%) to 42.3% (95% CI: 38.0-46.6%). CONCLUSIONS Between 1987 and 2012 the prevalence of obesity markedly increased in Spain among adults with diabetes.
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Affiliation(s)
- Francisco Javier Basterra-Gortari
- Department of Internal Medicine (Endocrinology), Hospital Reina Sofia, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Servicio Navarro de Salud-Osasunbidea, Tudela, Spain; University of Navarra, Department of Preventive Medicine and Public Health, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
| | - Maira Bes-Rastrollo
- University of Navarra, Department of Preventive Medicine and Public Health, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain; Centro de Investigación Biomédica en Red de la Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain
| | - Miguel Ruiz-Canela
- University of Navarra, Department of Preventive Medicine and Public Health, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain; Centro de Investigación Biomédica en Red de la Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain
| | - Alfredo Gea
- University of Navarra, Department of Preventive Medicine and Public Health, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain; Centro de Investigación Biomédica en Red de la Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain
| | - Carmen Sayón-Orea
- University of Navarra, Department of Preventive Medicine and Public Health, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain; Department of Preventive Medicine, Complejo Hospitalario de Navarra, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Servicio Navarro de Salud-Osasunbidea, Pamplona, Spain
| | - Miguel Ángel Martínez-González
- University of Navarra, Department of Preventive Medicine and Public Health, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain; Centro de Investigación Biomédica en Red de la Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain; Department of Nutrition, Harvard TH Chan School of Public Health, Boston, USA.
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14
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Herrero Gil AM, Pinillos Robles J, Sabio Repiso P, Martín Maldonado JL, Garzón González G, Gil de Miguel Á. [Trends in the level of control of patients with type 2 diabetes from 2010 to 2015]. Aten Primaria 2018; 50:459-466. [PMID: 28838742 PMCID: PMC6836903 DOI: 10.1016/j.aprim.2017.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 04/03/2017] [Accepted: 04/05/2017] [Indexed: 01/02/2023] Open
Abstract
INTRODUCTION Aim: To examine the trend in the level of control of glycated haemoglobin (HbA1c), blood pressure (BP), and LDL-cholesterol (LDL) in patients with type 2 diabetes mellitus between 2010 and 2015. METHODS Setting: 3 cut-offs in the years 2010, 2013, and 2015. Southeast area of Madrid. DESIGN Descriptive and cross-sectional epidemiological study. PARTICIPANTS Patients diagnosed and registered with type 2 diabetes. N=41,096 (2010), n=49,658 (2013), n=6,674 (2015) MAIN MEASUREMENTS: Measurement or not in the last year of HbA1c, BP, and LDL. Control of HbA1c (<7% individual targeting), BP (<140/90mmHg), and LDL (<100mg/dL, if cardiovascular disease <70mg/dL). Data were collected from electronic records of clinical history. The Chi-square test was used. RESULTS The percentages of patients with each parameter measured in 2010, 2013 and 2015 were: HbA1c: 36.4%, 37.0%, 62.0% (P<.001); BP: 33.2%, 43.3%, 65.0% (P<.001); LDL: 32.9%, 33.2%, 43.5% (P<.001). The percentages of patients with each parameter measured and controlled in 2010, 2013, and 2015 were: HbA1c: 59.6%, 59.1%, 79.6% (P<.001); BP: 74.9%, 67.4%, 79.2% (P<.001); LDL: 41.8%, 58.3%, 58.8% (P<.001) CONCLUSION: In the 2010-2015 period, a sustained but insufficient trend of better control of HbA1c, BP and LDL was observed in patients with diabetes. The frequency of the measurements of these parameters improved more than the control of them. It seems that efforts to improve care for the patient with diabetes pay off, but they still have to be maintained.
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Affiliation(s)
| | | | | | | | | | - Ángel Gil de Miguel
- Departamento de Medicina Preventiva y Salud Pública, Universidad Rey Juan Carlos, Madrid, España
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15
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Brugos-Larumbe A, Aldaz-Herce P, Guillen-Grima F, Garjón-Parra FJ, Bartolomé-Resano FJ, Arizaleta-Beloqui MT, Pérez-Ciordia I, Fernández-Navascués AM, Lerena-Rivas MJ, Berjón-Reyero J, Jusué-Rípodas L, Aguinaga-Ontoso I. Assessing variability in compliance with recommendations given by the International Diabetes Federation (IDF) for patients with type 2 diabetes in primary care using electronic records. The APNA study. Prim Care Diabetes 2018; 12:34-44. [PMID: 28732655 DOI: 10.1016/j.pcd.2017.06.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 02/01/2017] [Accepted: 06/15/2017] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Assess compliance with the IDF recommendations for patients with Diabetes Type2 (DM2), and its variability, by groups of doctors and nurses who provide primary care services in Navarre (Spain). MATERIALS AND METHODOLOGIES A cross-sectional study of a population of 462,568 inhabitants, aged ≥18 years in 2013, attended by 381 units of doctor/nurse (quota). Clinical data were collected retrospectively through electronic records. Using cluster analysis, we identified two groups of units according to the score for each indicator. We calculated the Odds Ratio, adjusted for age sex, BMI, socioeconomic status and smoking, for complying with each recommendation whether a patient was treated by one of the quota from the highest score to the lowest. 30,312 patients with DM2 were identified: prevalence: 6.39%; coefficient of variation between UDN: 22.8%; biggest cluster 7.7% and smallest 5.3%; OR=1.54 (1.50-1.58). The HbA1c control at ≤8% was 82.8% (82.2-83.3) and >9% was 7.6% (7.3-8.0), with OR 1.79 (1.69-1.89) and 2.62 (2.36-2.91) respectively. Control of BP and LDL-C show significant differences between the clusters. CONCLUSIONS An important variability was identified according to the doctor treating patients. The average HbA1c control is acceptable being limited in BP and LDL-C.
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Affiliation(s)
| | - Pablo Aldaz-Herce
- Primary Health Care, Navarra Health Service, Pamplona, Navarra, Spain.
| | - Francisco Guillen-Grima
- Dept. of Health Sciences, Public University of Navarra, Preventive Medicine University of Navarra Clinic, IdiSNA (Navarra Institute for Health Research), Pamplona, Navarra, Spain.
| | | | | | | | | | | | | | - Jesús Berjón-Reyero
- Hospital Complex of Navarra, Navarra Health Service, Pamplona, Navarra, Spain.
| | | | - Ines Aguinaga-Ontoso
- Dept. of Health Sciences, Public University of Navarra, Pamplona, Navarra, Spain.
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16
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Belay E, Abera A, Mehari A, Gebremeskel G, Endrias A, Endris K. Achievements of Diabetes Goals and Their Determinants in Type 2 Diabetic Patients Attending Outpatient Diabetic Clinic in Northern Ethiopia. Int J Chronic Dis 2017; 2017:5713187. [PMID: 29464189 PMCID: PMC5804378 DOI: 10.1155/2017/5713187] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Accepted: 11/29/2017] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND The aim of this study was to assess target diabetic goal achievements and to explore variables associated with them. METHODS A cross-sectional study was conducted between December 2015 and April 2016 on 188 type 2 diabetic patients attending Ayder Referral Hospital's outpatient diabetic clinic. Glycemic control was assessed using fasting plasma glucose values and total cholesterol and triglyceride were used to evaluate lipid profiles. Bivariate and multivariate logistic regression analyses were done to identify factors associated with poor glycemic control, hypertension, and dyslipidemia. RESULT Mean duration of diabetes was 6.5 years. Combined glycemic, lipid, and blood pressure targets were achieved only in 8.5% of the participants. More males achieved combined targets than females. Separately, while above two-thirds of the patients had poor glycemic control (67%), more than half of the participants have had poor lipid (58.5%) and blood pressure (52.1%) control. A significant portion of the patients (68.1%) had also comorbidities other than hyperglycemia. In bivariate and multivariate analyses, longer duration of diabetes disease (AOR: 3.4; P = 0.013) and marked month to month fasting plasma glucose (FPG) variability as measured by large standard deviation (AOR: 2.5; P = 0.023) were significantly associated with overall poor mean FPG results. Female sex was also significantly associated with dyslipidemia (AOR: 1.9; P = 0.049). CONCLUSION The study showed that achievements of combined diabetic goals are generally poor.
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Affiliation(s)
- Ezra Belay
- Department of Medical Biochemistry, College of Health Sciences, Mekelle University, 1871 Mekelle, Ethiopia
| | - Abel Abera
- Department of Medical Biochemistry, College of Health Sciences, Mekelle University, 1871 Mekelle, Ethiopia
| | - Aman Mehari
- Department of Medical Biochemistry, College of Health Sciences, Mekelle University, 1871 Mekelle, Ethiopia
| | - Gidey Gebremeskel
- Department of Medical Biochemistry, College of Health Sciences, Mekelle University, 1871 Mekelle, Ethiopia
| | - Asrat Endrias
- Department of Medical Biochemistry, College of Health Sciences, Mekelle University, 1871 Mekelle, Ethiopia
| | - Kedir Endris
- Department of Nursing, College of Health Sciences, Mekelle University, 1871 Mekelle, Ethiopia
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17
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Zuo HJ, Wang WH, Deng LQ, Su JL. Control of cardiovascular disease risk factors among patients with type II diabetes in a primary-care setting in Beijing. ACTA ACUST UNITED AC 2017; 12:128-134. [PMID: 29289467 DOI: 10.1016/j.jash.2017.12.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Accepted: 12/10/2017] [Indexed: 01/19/2023]
Abstract
The aim of this study was to assess the control of blood glucose, blood pressure (BP), serum low-density lipoprotein cholesterol (LDL-c), and other cardiovascular disease risk factors among patients with type II diabetes in a primary-care setting in Beijing. We performed a cross-sectional, multi-center survey of 4056 patients with type II diabetes aged ≥40 years. In total, 22.6% were current smokers, 10.8% often drank alcohol, 29.0% were obese, and 67.4% participated in adequate levels of physical activity. About 70% of patients reported comorbid hypertension or dyslipidemia. Of these, 70.8% were being treated for diabetes and 79.3% for hypertension; 20.5% were receiving statins and 28.5% aspirin. The proportions of patients achieving their therapeutic target were 52.6% for fasting plasma glucose, 58.2% for BP, and 33.0% for LDL-c. Only 11.1% achieved all three goals. Among 1960 (48.3%) patients with a record of hemoglobin A1C, 27.8% achieved the hemoglobin A1C target (<6.5%). These data suggest that blood glucose and BP were more likely to be well controlled than LDL-c, the likelihood of control of multiple risk factors is low, and that the statin and aspirin use should be intensified in patients with a substantial risk of cardiovascular disease.
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Affiliation(s)
- Hui-Juan Zuo
- Department of Community Health Research, Beijing Anzhen Hospital Affiliated to the Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China.
| | - Wen-Hua Wang
- Department of CVD Prevention and Control, Beijing Anzhen Hospital Affiliated to the Capital Medical University, Beijing, China
| | - Li-Qun Deng
- Department of General Practice, Beijing Anzhen Hospital Affiliated to the Capital Medical University, Beijing, China
| | - Jiang-Lian Su
- Department of Community Health Research, Beijing Anzhen Hospital Affiliated to the Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
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18
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Mata-Cases M, Mauricio D, Franch-Nadal J. Clinical characteristics of type 2 diabetic patients on basal insulin therapy with adequate fasting glucose control who do not achieve HbA1c targets. J Diabetes 2017; 9:34-44. [PMID: 26749415 DOI: 10.1111/1753-0407.12373] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 12/17/2015] [Accepted: 12/22/2015] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The aim of the present study was to determine the clinical characteristics of patients with type 2 diabetes mellitus (T2DM) treated with basal insulin who achieved an adequate fasting plasma glucose (FPG) level (<130 mg/dL), but were unable to achieve the HbA1c target (<7%; <53 mmol/mol). METHODS A cross-sectional study was performed on T2DM patients aged 31-90 years treated with basal insulin registered in the SIDIAPQ primary healthcare electronic database during 2010. RESULTS In 2010, of a population of 126 811 T2DM subjects, 9899 were treated with basal insulin (neutral protamine Hagedorn [NPH], detemir, or glargine). Of these, 23.5% (n = 2322) achieved optimal FPG control levels (<130 mg/dL) but an inadequate HbA1c target (>7%). Mean HbA1c values in the contolled and uncontrolled groups were 8.15% (65.6 mmol/mol) and 6.31% (45.5 mmol/mol), respectively. Patients with controlled FPG but uncontrolled HbA1c had longer T2DM duration (11.6 vs 9.9 years), higher systolic blood pressure (138.2 vs 136.3 mmHg) and low-density lipoprotein cholesterol (104 vs 99 mg /dL), and a higher prevalence of retinopathy (24.8% vs 18.2%) than patients (17.8%) with optimal control of both glycemic targets (P < 0.05). Multivariate analysis showed that inadequate glycemic control was positively related only to younger age. CONCLUSION One-quarter of T2DM patients treated with basal insulin have difficulties attaining the recommended HbA1c goal despite adequate FPG levels. As some guidelines state, healthcare professionals should focus on PPG to identify and intensify treatment to control prandial glucose excursions in these patients.
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Affiliation(s)
- Manel Mata-Cases
- Jordi Gol Institute for Research in Primary Care (Institut Universitari d'Investigació en Atenció Primària Jordi Gol), Barcelona, Spain
- Primary Health Care Centre La Mina, Barcelona, Spain
- Biomedical Research Network in Diabetes and Associated Metabolic Disorders (Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas -CIBERDEM-). Instituto de Salud Carlos III, Madrid, Spain
| | - Dídac Mauricio
- Jordi Gol Institute for Research in Primary Care (Institut Universitari d'Investigació en Atenció Primària Jordi Gol), Barcelona, Spain
- Department of Endocrinology and Nutrition, Hospital Germans Trias i Pujol, Badalona, Spain
- Biomedical Research Network in Diabetes and Associated Metabolic Disorders (Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas -CIBERDEM-). Instituto de Salud Carlos III, Madrid, Spain
| | - Josep Franch-Nadal
- Jordi Gol Institute for Research in Primary Care (Institut Universitari d'Investigació en Atenció Primària Jordi Gol), Barcelona, Spain
- Primary Health Care Centre Raval Sud, Institut Català de la Salut, Barcelona, Spain
- Biomedical Research Network in Diabetes and Associated Metabolic Disorders (Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas -CIBERDEM-). Instituto de Salud Carlos III, Madrid, Spain
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19
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Cambra K, Galbete A, Forga L, Lecea O, Ariz MJ, Moreno-Iribas C, Aizpuru F, Ibañez B. Sex and age differences in the achievement of control targets in patients with type 2 diabetes: results from a population-based study in a South European region. BMC FAMILY PRACTICE 2016; 17:144. [PMID: 27729015 PMCID: PMC5060013 DOI: 10.1186/s12875-016-0533-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 09/10/2016] [Indexed: 01/17/2023]
Abstract
Background We aimed to determine the degree to which control targets of glycaemia and cardiovascular risk factors were achieved among patients with type 2 diabetes and to investigate sex- and age-related differences in this population. Methods This cross-sectional, population-based study was conducted in Spain. Glycated hemoglobin (HbA1c), blood pressure, LDL-c, HDL-c, triglycerides, BMI, and smoking history were obtained from electronic clinical primary care records (n = 32,638 cases). The proportions of patients who met control targets were determined according to sex and age groups. Comparisons between groups were conducted with t-tests for continuous variables, tests for trends in proportions for categorical and ordinal variables, and Pearson’s chi-square tests and binary logistic regression models for categorical variables. Results The overall proportions of patients with type 2 diabetes who met the target objectives for HbA1c (<7 %, 53 mmol/mol), blood pressure (130/80 mmHg), and LDL-cholesterol (100 mg/dl) were 60, 40 and 41 %, respectively. Women were less likely than men to meet the control targets of HbA1c (59 vs 61 %), LDL (35 vs 45 %), and HDL (58 vs 78 %). Patients under 65 years of age presented poorer control than older age groups. Only a minority of patients with type 2 diabetes met the composite target objectives for glycemic control, blood pressure, and LDL. Conclusions There are differential gaps in the control results of female patients and younger patients, which should prompt improvements in case management and care. There is room for further improvement in the cardiometabolic control of patients with type 2 diabetes. Electronic supplementary material The online version of this article (doi:10.1186/s12875-016-0533-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- K Cambra
- Navarrabiomed-FMS, C/ Irunlarrea 8, Recinto CHN, 31008, Pamplona, Spain. .,Health Services Research on Chronic Patients Network (REDISSEC), Pamplona, Spain. .,IdiSNA, Pamplona, Spain.
| | - A Galbete
- Navarrabiomed-FMS, C/ Irunlarrea 8, Recinto CHN, 31008, Pamplona, Spain.,Health Services Research on Chronic Patients Network (REDISSEC), Pamplona, Spain
| | - L Forga
- IdiSNA, Pamplona, Spain.,Complejo Hospitalario de Navarra, Servicio Navarro de Salud-Osasunbidea, Pamplona, Spain
| | - O Lecea
- Gerencia de Atención Primaria, Servicio Navarro de Salud-Osasunbidea, Pamplona, Spain
| | - M J Ariz
- Gerencia de Atención Primaria, Servicio Navarro de Salud-Osasunbidea, Pamplona, Spain
| | - C Moreno-Iribas
- Health Services Research on Chronic Patients Network (REDISSEC), Pamplona, Spain.,IdiSNA, Pamplona, Spain.,Instituto de Salud Pública y Laboral de Navarra, Pamplona, Spain
| | - F Aizpuru
- Health Services Research on Chronic Patients Network (REDISSEC), Pamplona, Spain.,Hospital de Txagorritxu, Servicio Vasco de Salud-Osakidetza, Vitoria Gasteiz, Spain
| | - B Ibañez
- Navarrabiomed-FMS, C/ Irunlarrea 8, Recinto CHN, 31008, Pamplona, Spain.,Health Services Research on Chronic Patients Network (REDISSEC), Pamplona, Spain.,IdiSNA, Pamplona, Spain
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20
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Miñambres I, Mediavilla JJ, Sarroca J, Pérez A. Meeting individualized glycemic targets in primary care patients with type 2 diabetes in Spain. BMC Endocr Disord 2016; 16:10. [PMID: 26887662 PMCID: PMC4756540 DOI: 10.1186/s12902-016-0090-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 02/09/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Information about the achievement of glycemic targets in patients with type 2 diabetes according to different individualization strategies is scarce. Our aim was to analyze the allocation of type 2 diabetic patients into individualized glycemic targets according to different strategies of individualization and to assess the degree of achievement of adequate control. METHODS Cross-sectional analysis on 5382 type 2 diabetic patients in primary care setting in Spain between 2011 and 2012. Targets of HbA1c were assigned based on different strategies of individualization of glycemic targets: 1) the ADA/EASD consensus 2) The Spanish Diabetes Society (SED) consensus 3) a strategy that accounts for the risk of hypoglycemia (HYPO) considering the presence of a hypoglycemia during the last year and type of hypoglycemic treatment. Concordance between the different strategies was analyzed. RESULTS A total of 15.9, 17.1 and 67 % applied to ADA/EASD recommendation of HbA1c target of <6.5, < 7 and <8 % (48, 53 and 64 mmol/mol), and 31.9 and 67.4 % applied to the SED glycemic target of <6.5 and <7.5 % (<48 and 58 mmol/mol). Using the HYPO strategy, 53.5 % had a recommended HbA1c target <7 % (53 mmol/mol). There is a 94 % concordance between the ADA/EASD and SED strategies, and a concordance of 41-42 % between these strategies and HYPO strategy. Using the three different strategies, the overall proportion of patients achieving glycemic targets was 56-68 %. CONCLUSIONS Individualization of glycemic targets increases the number of patients who are considered adequately controlled. The proposed HYPO strategy identifies a similar proportion of patients that achieve adequate glycemic control than ADA/EASD or SED strategies, but its concordance with these strategies in terms of patient classification is bad.
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Affiliation(s)
- I Miñambres
- Department of Endocrinology and Nutrition Services, Hospital de la Santa Creu i Sant Pau, C/ Sant Quintí, 89, 08026, Barcelona, Spain
- Research Institute, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | | | - A Pérez
- Department of Endocrinology and Nutrition Services, Hospital de la Santa Creu i Sant Pau, C/ Sant Quintí, 89, 08026, Barcelona, Spain.
- Research Institute, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
- Department of Medicine, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.
- Diabetes and Metabolic Diseases CIBER (CIBERDEM), Barcelona, Spain.
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21
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Alonso-Fernández M, Mancera-Romero J, Mediavilla-Bravo JJ, Comas-Samper JM, López-Simarro F, Pérez-Unanua MP, Iturralde-Iriso J. Glycemic control and use of A1c in primary care patients with type 2 diabetes mellitus. Prim Care Diabetes 2015; 9:385-391. [PMID: 25686480 DOI: 10.1016/j.pcd.2015.01.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Revised: 12/28/2014] [Accepted: 01/22/2015] [Indexed: 11/24/2022]
Abstract
AIMS To evaluate the degree of glycemic control and its relationship with disease characteristics and antidiabetic treatment in patients with type 2 diabetes mellitus (DM), as well as the frequency of A1c use. METHODS For this purpose, an observational, cross-sectorial, and multicenter study was performed. A total of 443 patients were monitored in 17 Spanish primary healthcare centers. Demographic and clinical variables were recorded from the clinical history of patients. RESULTS Mean age was 68.9±12.0 years. Time of evolution of DM was 9.2±6.4 years. Mean A1c was 7.38±1.34% and 45% of patients achieved A1c <7%. There was a no significant relationship between the degree of control and time of evolution of DM. In 16% of patients no A1c determination was performed in the previous twelve months. In those patients in whom A1c was determined, 95% received pharmacologic treatment, and 31% insulin therapy. 66% of patients on monotherapy attained A1C <7%, compared with 39% and 23% of those receiving double- and triple-oral therapy, respectively (p<0.001). Only 21% of patients on insulin therapy achieved A1c <7%. The worst-controlled patients were those receiving oral antidiabetic agents and insulin (24% had A1c levels ≥9%). CONCLUSIONS A large proportion of patients are poorly controlled. Poor control increases according to complexity of treatment. A1c is underdetermined in many patients, likely related to clinical inertia.
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Affiliation(s)
- Margarita Alonso-Fernández
- Centro de Salud La Ería, Asturias, Spain; Departamento de Medicina Preventiva y Salud Publica, Universidad de Oviedo, Asturias, Spain.
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22
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Franch-Nadal J, Roura-Olmeda P, Benito-Badorrey B, Rodriguez-Poncelas A, Coll-de-Tuero G, Mata-Cases M. Metabolic control and cardiovascular risk factors in type 2 diabetes mellitus patients according to diabetes duration. Fam Pract 2015; 32:27-34. [PMID: 25194144 DOI: 10.1093/fampra/cmu048] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Control of glycaemic levels as well as cardiovascular risk factors (CVRF) is essential to prevent the onset of complications associated with type 2 diabetes mellitus (T2DM). AIM To describe the degree of glycaemic control and CVRF in relation to diabetes duration. PATIENTS AND METHODS Multicentre cross-sectional study in T2DM patients seen in primary care centres during 2007. VARIABLES Demographical and clinical characteristics, antidiabetic treatments and development of disease complications. Diabetes duration classification: 0-5, 6-10, 11-20 and >20 years. Logistic regression models were used in the analysis. RESULTS A total of 3130 patients; 51.5% males; mean age: 68±11.7 years; mean diabetes duration:7.0 (±5.6) years, median: 5 (interquartile range:3-9) years; mean HbA1c: 6.84 (±1.5), were analyzed. There has been a progressive decline in HbA1c levels (HbA1c > 7% in 25.8% of patients during the first 5 years and 51.8% after 20 years). Blood pressure values remained relatively stable throughout disease duration. The mean value of low density lipoprotein (LDL) experienced a slight decline with the progression of the disease, but due to the significant increase of cardiovascular disease (CVD) after 20 years of duration, less patients reached the recommended target (LDL < 100mg/dl) in secondary prevention. Logistic regression model controlling for age, sex and CVD showed that diabetes duration was related to glycaemic control (odds ratio: 1.066, 95% confidence interval: 1.050-1.082 per year) but not to blood pressure or LDL control. CONCLUSIONS The degree of glycaemic control and the risk factors in relation to the duration of T2DM followed different patterns. Diabetes duration was associated with a poorer glycaemic control but in general had a limited role in blood pressure control or lipid profile.
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Affiliation(s)
- Josep Franch-Nadal
- Primary Care Center Raval Sud, Barcelona, Spain; Barcelona Ciutat Research Support Unit - IDIAP Jordi Gol, Barcelona, Spain;
| | | | | | | | - Gabriel Coll-de-Tuero
- PCC Anglés, Girona, Spain; Research Unit, Healthcare Institute, Girona, Spain; Translab. Departament of Medical Sciences, University of Girona, Girona, Spain and
| | - Manel Mata-Cases
- Barcelona Ciutat Research Support Unit - IDIAP Jordi Gol, Barcelona, Spain; PCC La Mina, Sant Adrià de Besòs, Barcelona, Spain
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23
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Lucas Martín AM, Guanyabens E, Zavala-Arauco R, Chamorro J, Granada ML, Mauricio D, Puig-Domingo M. Breaking Therapeutic Inertia in Type 2 Diabetes: Active Detection of In-Patient Cases Allows Improvement of Metabolic Control at Midterm. Int J Endocrinol 2015; 2015:381415. [PMID: 26089883 PMCID: PMC4451772 DOI: 10.1155/2015/381415] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Revised: 10/05/2014] [Accepted: 10/05/2014] [Indexed: 01/06/2023] Open
Abstract
Type 2 diabetes (T2D) exists in 25-40% of hospitalized patients. Therapeutic inertia is the delay in the intensification of a treatment and it is frequent in T2D. The objectives of this study were to detect patients admitted to surgical wards with hyperglycaemia (HH; fasting glycaemia > 140 mg/dL) as well as those with T2D and suboptimal chronic glycaemic control (SCGC) and to assess the midterm impact of treatment modifications indicated at discharge. A total of 412 HH patients were detected in a period of 18 months; 86.6% (357) had a diagnosed T2D. Their preadmittance HbA1c was 7.7 ± 1.5%; 47% (189) had HbA1c ≥ 7.4% (SCGC) and were moved to the upper step in the therapeutic algorithm at discharge. Another 15 subjects (3.6% of the cohort) had T2D according to their current HbA1c. Ninety-four of the 189 SCGC patients were evaluated 3-6 months later. Their HbA1c before in-hospital-intervention was 8.6 ± 1.2% and 7.5 ± 1.2% at follow-up (P < 0.004). Active detection of hyperglycaemia in patients admitted in conventional surgical beds permits the identification of T2D patients with SCGC as well as previously unknown cases. A shift to the upper step in the therapeutic algorithm at discharge improves this control. Hospitalization is an opportunity to break therapeutic inertia.
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Affiliation(s)
- Anna M. Lucas Martín
- Endocrinology and Nutrition Service, Germans Trias i Pujol Research Institute and Hospital, Department of Medicine, Autonomous University of Barcelona, Can Ruti Campus, Ctra. Canyet s/n, Badalona, 08916 Barcelona, Spain
- *Anna M. Lucas Martín:
| | - Elena Guanyabens
- Endocrinology and Nutrition Service, Germans Trias i Pujol Research Institute and Hospital, Department of Medicine, Autonomous University of Barcelona, Can Ruti Campus, Ctra. Canyet s/n, Badalona, 08916 Barcelona, Spain
| | - R. Zavala-Arauco
- Endocrinology and Nutrition Service, Germans Trias i Pujol Research Institute and Hospital, Department of Medicine, Autonomous University of Barcelona, Can Ruti Campus, Ctra. Canyet s/n, Badalona, 08916 Barcelona, Spain
| | - Joaquín Chamorro
- Endocrinology and Nutrition Service, Germans Trias i Pujol Research Institute and Hospital, Department of Medicine, Autonomous University of Barcelona, Can Ruti Campus, Ctra. Canyet s/n, Badalona, 08916 Barcelona, Spain
| | - Maria Luisa Granada
- Hormone Laboratory, Germans Trias i Pujol Research Institute and Hospital, Department of Medicine, Autonomous University of Barcelona, Can Ruti Campus, Ctra. Canyet s/n, Badalona, 08916 Barcelona, Spain
| | - Didac Mauricio
- Endocrinology and Nutrition Service, Germans Trias i Pujol Research Institute and Hospital, Department of Medicine, Autonomous University of Barcelona, Can Ruti Campus, Ctra. Canyet s/n, Badalona, 08916 Barcelona, Spain
| | - Manuel Puig-Domingo
- Endocrinology and Nutrition Service, Germans Trias i Pujol Research Institute and Hospital, Department of Medicine, Autonomous University of Barcelona, Can Ruti Campus, Ctra. Canyet s/n, Badalona, 08916 Barcelona, Spain
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24
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Ruiz de Adana M, Soriguer F. Control glucémico en pacientes con diabetes mellitus tipo 2 en España: ¿Quo vadis? Rev Clin Esp 2014; 214:453-4. [DOI: 10.1016/j.rce.2014.05.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Accepted: 05/22/2014] [Indexed: 10/25/2022]
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25
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Pérez A, Mediavilla J, Miñambres I, González-Segura D. Glycemic control in patients with type 2 diabetes mellitus in Spain. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.rceng.2014.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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26
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Díaz Rodríguez A, Murga N, Camafort-Babkowski M, López Peral JC, Ruiz E, Ruiz-Baena J, Valdivielso P. Therapeutic inertia in hypercholesterolaemia is associated with ischaemic events in primary care patients. A case-control study. Int J Clin Pract 2014; 68:1001-9. [PMID: 24667004 DOI: 10.1111/ijcp.12419] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The frequency of therapeutic inertia (TI) is very high in the management of vascular risk factors, although its impact on the incidence of ischaemic events is not well-established. Our aim was to investigate the relationship between TI in the treatment of hypercholesterolaemia and the appearance of ischaemic events. METHODS An observational, multicentre, case-control study was conducted in 70 primary care centres in Spain. Case subjects (n = 235) were high-risk hypercholesterolaemic patients (both genders, ≥ 18 years) who had had a first event in the 12 months prior to recruitment. They were matched with 235 controls (by vascular risk, age and gender). The observation period was 18 months prior to the onset of a first event (cases) or to date of recruitment (control subjects). RESULTS The TI in the basal visit (an average of 7.8 months before the event) was slightly higher in cases than in controls (39.7% vs. 34.8%, NS). However, the accumulated TI was similar in both groups (70.7% for cases and 73.95% for controls, NS). The multivariate analysis, taking ischaemic events as the dependent variable, showed that the TI at baseline visit was significantly associated with the development of the event [OR 2.18 (95% CI 1.04-4.51), p < 0.05]. Other variables also associated with the ischaemic event were a family history of premature vascular disease [OR 3.38 (95% CI 1.35-8.49), p < 0.05] and uncontrolled hypertension [OR 2.35 (95% CI 1.02-5.43), p < 0.05]. CONCLUSION The TI in high-risk hypercholesterolaemic patients in primary prevention in Spanish primary care centres doubled the risk of an ischaemic event in the short term.
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27
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Navarro Oliver AF, Martínez Navarro A, Martínez Navarro MA, Leal Hernández M. [What do type II diabetics know about cardiovascular risk factors? Relationship with the level of control of these factors]. Semergen 2014; 40:352-3. [PMID: 25016943 DOI: 10.1016/j.semerg.2013.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2013] [Accepted: 11/06/2013] [Indexed: 11/30/2022]
Affiliation(s)
- A F Navarro Oliver
- Enfermera, Centro de Salud Docente de San Andrés, Murcia, España; Profesora, Facultad de Enfermería. Universidad Católica de Murcia (UCAM), Murcia, España
| | | | | | - M Leal Hernández
- Médico de Familia, Centro de Salud Docente de San Andrés, Murcia, España.
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28
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Pérez A, Mediavilla JJ, Miñambres I, González-Segura D. Glycemic control in patients with type 2 diabetes mellitus in Spain. Rev Clin Esp 2014; 214:429-36. [PMID: 25016415 DOI: 10.1016/j.rce.2014.05.028] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Revised: 05/12/2014] [Accepted: 05/25/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate the degree of glycemic control in patients with type 2 diabetes in Spain and identify factors associated with glycemic control. PATIENTS AND METHODS This was a cross-sectional, multicenter, epidemiological study that used consecutive sampling and was conducted in primary care practices in Spain. A total of 5591 patients with type 2 diabetes mellitus lasting more than 1 year and who were treated with hypoglycemic agents for more than 3 months were included in the study. At a single visit, HbA1c levels were measured (A1cNow+ system) and demographic and clinical variables related to diabetes and its treatment were recorded. During the visit, CV risk factors (CVRF), the presence of target-organ damage (TOD), the presence of hypoglycemia and body weight changes within the previous year were recorded. RESULTS We analyzed data from 5382 patients (mean age 66.7 [10.8] years, mean duration of the diabetes 8.8 [6.3] years). TOD was present in 43.6% of the patients and 59.1% were taking 2 or more drugs. The patients' mean HbA1c was 7.1 (1.1)%, and 48.6% had HbA1c levels <7.0%. The patients with HbA1c levels ≥7.0% had longer-standing diabetes, a higher prevalence of TOD and CVRF, used more complex therapies, experienced more hypoglycemic episodes in the previous year and had more weight gain. In the multivariate analysis, the absence of insulin treatment, the absence of abdominal obesity and atherogenic dyslipidemia, a duration of the diabetes <10 years and an age >70 years were associated with improved glycemic control. CONCLUSIONS Patients with poorly controlled type 2 diabetes mellitus are highly prevalent in Spain. Factors associated with poorer glycemic control include the complexity of both the disease and the hypoglycemic therapy, a history of hypoglycemia and weight gain.
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Affiliation(s)
- A Pérez
- Servicio de Endocrinología y Nutrición, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, España; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM) , Barcelona, España.
| | | | - I Miñambres
- Servicio de Endocrinología y Nutrición, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, España
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Lucha-López MO, Lucha-López AC, Vidal-Peracho C, Tricás-Moreno JM, Estébanez-De Miguel E, Salavera-Bordás C, Hidalgo-García C. Analysis of a sample of type 2 diabetic patients with obesity or overweight and at cardiovascular risk: a cross sectional study in Spain. BMC Res Notes 2014; 7:48. [PMID: 24443817 PMCID: PMC3901755 DOI: 10.1186/1756-0500-7-48] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Accepted: 01/15/2014] [Indexed: 01/26/2023] Open
Abstract
Background The multifactorial control of diabetes relies on interventions that provide patients with the best knowledge and resources available. The objective of this research was to analyze the clinical characteristics of a sample of people with type 2 diabetes at high cardiovascular risk, and establish possible links between disease control, family history and lifestyle, to improve the quality of interventions. Family history, lifestyle habits, blood pressure, anthropometric data and laboratory tests were analyzed in this descriptive and comparative cross-sectional study. Results All patients had a pathological body mass index (BMI), and in those patients with a family history of diabetes, the disease was more serious and onset was earlier. Overall, 70.9% were taking drugs for arterial blood pressure management, with mean values within recommended limits; 87.1% were taking antihyperlipidemic drugs and had mean values for blood lipids within reference range; 93.5% were receiving oral antidiabetic drugs and/or insulin and had blood glucose and glycosylated hemoglobin (HbA1c) values higher than recommended limit; and 87% were taking antiplatelet drugs and had fibrinogen and ultrasensitive C-reactive protein higher than the normal range. High HbA1c values were found in a high proportion of our sample who were not following a tailored diet (84.2%), and better BMIs were associated with moderate physical activity. Coexistence of somatic disorders (97.4% of the sample with musculoskeletal diseases) could lead to the lack of physical activity. Conclusions This sample of patients with type 2 diabetes and at high cardiovascular risk, had acceptable metabolic control, facilitated by drug therapy. Family history of diabetes was associated with earlier disease onset and worse disease progression. Patients who were not following a tailored diet had worse HbA1c values compared with those who were. Individuals who practiced moderate physical activity in line with international recommendations for weight maintenance had the best BMI values, but the high prevalence of comorbidities could adversely affect exercise habits. Appropriate use of medication, dietary advice, and tailored physiotherapy physical activity suitable for people with comorbidities should be included in multifactorial treatment strategies for these patients, particularly in the presence of a family history of diabetes.
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Affiliation(s)
- María Orosia Lucha-López
- Physiotherapy Research Unit, Faculty of Health Sciences - University of Zaragoza, C/Domingo Miral s/n, 50009, Zaragoza, Spain.
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Catalán-Ramos A, Verdú JM, Grau M, Iglesias-Rodal M, del Val García JL, Consola A, Comin E. Population prevalence and control of cardiovascular risk factors: what electronic medical records tell us. Aten Primaria 2013; 46:15-24. [PMID: 24325864 PMCID: PMC6983525 DOI: 10.1016/j.aprim.2013.06.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Revised: 06/14/2013] [Accepted: 06/17/2013] [Indexed: 12/18/2022] Open
Abstract
Objective To analyze the prevalence, control, and management of hypertension, hypercholesterolemia, and diabetes mellitus type 2 (DM2). Design Cross-sectional analysis of all individuals attended in the Catalan primary care centers between 2006 and 2009. Location History of cardiovascular diseases, diagnosis and treatment of hypertension, hypercholesterolemia, DM2, lipid profile, glycemia and blood pressure data were extracted from electronic medical records. Age-standardized prevalence and levels of management and control were estimated. Participants Individuals aged 35–74 years using primary care databases. Main measures A total of 2,174,515 individuals were included (mean age 52 years [SD 11], 47% men). Results Hypertension was the most prevalent cardiovascular risk factor (39% in women, 41% in men) followed by hypercholesterolemia (38% and 40%) and DM2 (12% and 16%), respectively. Diuretics and angiotensin-converting enzyme inhibitors were most often prescribed for hypertension control (<140/90 mmHg, achieved in 68% of men and 60% of women treated). Hypercholesterolemia was controlled (low-density lipoprotein cholesterol <130 mg/dl) in just 31% of men and 26% of women with no history of cardiovascular disease, despite lipid-lowering treatment, primarily (90%) with statins. The percentage of women and men with DM2 and with glycated hemoglobin <7% was 64.7% and 59.2%, respectively; treatment was predominantly with oral hypoglycemic agents alone (70%), or combined with insulin (15%). Conclusions Hypertension was the most prevalent cardiovascular risk factor in the Catalan population attended at primary care centers. About two thirds of individuals with hypertension or DM2 were adequately controlled; hypercholesterolemia control was particularly low.
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Affiliation(s)
- Arantxa Catalán-Ramos
- Àmbit d'Avaluació de Farmàcia, Agència de Qualitat i Avaluació Sanitàries de Catalunya, Barcelona, Spain; Unitat de Coordinació i Estratègia del Medicament, Direcció Adjunta d'Afers Assistencials, Institut Català de la Salut, Barcelona, Spain.
| | - Jose M Verdú
- Institut Català de la Salut, Barcelona, Spain; Universitat Autònoma de Barcelona, Spain
| | - María Grau
- IMIM - Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain
| | | | - José L del Val García
- Institut Català de la Salut, Barcelona, Spain; Institut d'Investigació en Atenció Primària Jordi Gol, Barcelona, Spain
| | - Alicia Consola
- Aplicaciones en Informática Avanzada (AIA) S.L., Barcelona, Spain
| | - Eva Comin
- Unitat de Coordinació i Estratègia del Medicament, Direcció Adjunta d'Afers Assistencials, Institut Català de la Salut, Barcelona, Spain
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Mata-Cases M, Benito-Badorrey B, Roura-Olmeda P, Franch-Nadal J, Pepió-Vilaubí JM, Saez M, Coll-de-Tuero G. Clinical inertia in the treatment of hyperglycemia in type 2 diabetes patients in primary care. Curr Med Res Opin 2013; 29:1495-502. [PMID: 23944631 DOI: 10.1185/03007995.2013.833089] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To assess clinical inertia, defined as failure to intensify antidiabetic treatment of patients who have not achieved the HbA1c therapeutic goal (≤7%). RESEARCH DESIGN AND METHODS Multicenter cross-sectional study. Clinical inertia was assessed in a random sample of type 2 diabetes mellitus (T2DM) patients seen in primary care centers. RESULTS A total of 2783 patients (51.3% males; mean age: 68 [±11.5] years; diabetes duration: 7.1 [±5.6] years; mean HbA1c: 6.8 [±1.5]) were analyzed. Of those, 997 (35.8%) had HbA1c >7%. Treatment was intensified in 66.8% and consisted of: dose increase (40.5%); addition of oral antidiabetic (45.8%); or insulin treatment initiation (3.7%). Mean HbA1c values in patients for whom treatment was intensified vs. non-intensified were 8.4% (±1.2) vs. 8.2% (±1.2), p < 0.05. Clinical inertia was detected in 33.2% of patients and diminished along with treatment complexity: lifestyle changes only (38.8%), oral monotherapy (40.3%), combined oral antidiabetics (34.5%), insulin monotherapy (26.1%) and combination of insulin and oral antidiabetics (21.4%). Clinical inertia decreased as HbA1c increased: 37.3% for HbA1c values ranging between 7.1%-8%; 29.4% for the 8.1%-9% HbA1c range and 27.1% for HbA1c ≥9%. Multivariate analysis confirmed that diabetes duration, step of treatment and HbA1c were related to inertia. For each unit of HbA1c increase clinical inertia decreased 47% (OR: 0.53). LIMITATIONS The retrospective design of the study precluded an accurate investigation about reasons for lack of intensification that could actually be justified by some patient conditions, especially patients' lack of adherence. CONCLUSIONS Clinical inertia affected one third of T2DM patients with poor glycemic control and was greater in patients treated with only lifestyle changes or oral monotherapy. Treatment changes were performed when mean HbA1c values were 1.4 points above therapeutic goals.
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Affiliation(s)
- Manel Mata-Cases
- Primary Care Center (PCC) La Mina, Sant Adrià de Besòs , Barcelona , Spain
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32
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Mata-Cases M, Franch-Nadal J, Mauricio D, Bolíbar B. Investigar en diabetes desde una base de datos de atención primaria: la experiencia del Sistema de Información para el Desarrollo de la Investigación en Atención Primaria (SIDIAP). ACTA ACUST UNITED AC 2013. [DOI: 10.1016/j.avdiab.2013.09.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Carratalá-Munuera MC, Gil-Guillen VF, Orozco-Beltran D, Navarro-Pérez J, Caballero-Martínez F, Alvarez-Guisasola F, García-Soidán J, Fluixá-Carrascosa C, Franch-Nadal J, Martín-Rioboó E, Carrillo-Fernández L, Artola-Menéndez S. Barriers associated with poor control in Spanish diabetic patients. A consensus study. Int J Clin Pract 2013; 67:888-94. [PMID: 23758484 DOI: 10.1111/ijcp.12160] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Accepted: 02/20/2013] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Delphi technique allows developing a multidisciplinary consensus to establish solutions. AIM To identify barriers and solutions to improve control in patients with Type-2 Diabetes Mellitus (DM2). METHODS An observational study using the 2-round Delphi technique (June-August 2011). A panel of 108 experts in DM2 from medical and nursing fields (primary care providers and specialists) from different regions completed via email a questionnaire with 41 Likert statements and 9 scores for each one. Level of agreement was assessed using measures of central tendency and dispersion. We analysed commonalities/differences between the two groups (Kappa index and McNemar chi-square). RESULTS Response rate: 65%. Degree of agreement: 63.4% (95% CI 48.7-78.1%) in medicine, and 78.1% (95% CI 65.4-90.8) in nursing (p > 0.05). Overall level of agreement: Kappa = 0.43, (χ(2) = 2.5 p > 0.05). Regarding non-compliance with therapy, it improves with: the information to the partner/family/caregiver, patient education degree in diabetes, patient motivation and ability to share and agree on decisions with the patient. Clinical inertia improves with: motivation degree of healthcare professionals and the calculation of cardiovascular risk; and gets worse with: the shortage of time in consultation, absence of data in medical record, border high limits measurements accepted as normal readings, lack of a treatment goals, lack of teamwork (Physician/Nurse), scarcity of resources and lack of alarm systems in the electronic medical record on goals to achieve. CONCLUSION The participants achieved an agreement in interventions in non-therapeutic compliance and clinical inertia to improve DM2 control.
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Affiliation(s)
- M C Carratalá-Munuera
- Cátedra de Medicina de Familia, Departamento de Medicina Clínica, Universidad Miguel Hernández, Alicante, Spain.
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Primary care of patients with high cardiovascular risk : Blood pressure, lipid and diabetic target levels and their achievement in Hungary. Wien Klin Wochenschr 2013; 125:371-80. [PMID: 23824265 DOI: 10.1007/s00508-013-0379-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Accepted: 05/12/2013] [Indexed: 12/19/2022]
Abstract
Cardiovascular diseases are responsible for the majority of premature deaths in Hungary as well. Most of them could be prevented with healthy lifestyle of patients and adequate drug prescription of primary care physicians. Earlier European surveys found wide differences between the practices and achievements of different countries in this field. The study was based on and designed according to the framework of previous European Action on Secondary and Primary Prevention by Intervention to Reduce Events (EUROASPIRE) studies and aimed presenting Hungarian results and comparing with the achievements of other countries and previous Hungarian surveys. Among rural and urban settings, 679 patients under continuous care (236 diabetics, 218 with dyslipidaemia, and 225 with hypertension) were consecutively selected by 20 experienced general practitioners. The mean age of patients was 60.3 years (men) and 64.0 years (women). Among diabetics, less than 7 % of glycated hemoglobin (HbA1c) values were found in 42.5 % patients, while only 11.4 % patients had fasting plasma sugar less than 6.0 mmol/L. Of the patients treated for dyslipidaemia, the target level of triglyceride was reached by 40.6 %, recommended total cholesterol by 14.2 % and the HDL-cholesterol by 71.8 %. The therapeutic control of total and HDL-cholesterol was better in men, although women had better triglyceride values. The achievement among patients with hypertension was 42.0 %. Significantly higher blood pressure was measured by patients who were treated with not recommended combinations of antihypertensive medication. A remarkable improvement could be observed in Hungary in the field of secondary prevention. It was greater among patients with hypertension and dyslipidaemia and smaller in diabetes care. Compared to the results of published European surveys, Hungary occupies a good position, but further improvement is still required.
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Ardigò D, Vaccaro O, Cavalot F, Rivellese AA, Franzini L, Miccoli R, Patti L, Boemi M, Trovati M, Zavaroni I. Effectiveness of treat-to-target strategy for LDL-cholesterol control in type 2 diabetes: post-hoc analysis of data from the MIND.IT study. Eur J Prev Cardiol 2012; 21:456-63. [PMID: 23147277 DOI: 10.1177/2047487312467746] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND The paper presents a post-hoc analysis of the intensity of dyslipidaemia care operated in the first 2 years of Multiple-Intervention-in-type-2-Diabetes.ITaly (MIND.IT) study. DESIGN AND METHODS MIND.IT is a multicentric, randomized, two-parallel arm trial involving 1461 type 2 diabetic patients at high cardiovascular (CV) risk. The study compares the usual care (UC) of CV prevention with a multifactorial intensive care (IC) approach aiming at achieving target values for the main CV risk factors according to a step-wise treat-to-target approach. RESULTS Proportion of patients on target for low-density lipoprotein cholesterol (LDL-C) was about 10% at baseline and increased significantly more with IC than UC (43 vs. 27%; p < 0.001). However, the majority (57%) of patients, in this intended intensively treated cohort, failed to achieve the proposed target. Average LDL-C decreased from 144 ± 35 to 108 ± 31 mg/dl with IC and from 142 ± 28 to 118 ± 32 with UC (p-for-interaction <0.0001). IC was associated with a significantly greater increase in statin prescription and lower withdrawal from treatment than UC (43 vs. 11% and 28 vs. 61%, respectively; both p < 0.001). However, the new treatments were characterized in both groups by the use of low starting doses (≤ 10 mg of atorvastatin, equivalent dose in more than 90% of patients) without increase in case of missed target. CONCLUSIONS The application of a multifactorial treat-to-target intervention is associated with a significant improvement in LDL-C beyond usual practice. However, the change in LDL-C appears to be more related to an increased number of treated patients and a decreased treatment withdrawal than to a true treat-to-target approach.
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[Patient and health professional perceptions on the quality of care provided to diabetic patients]. ACTA ACUST UNITED AC 2012; 28:124-31. [PMID: 22999530 DOI: 10.1016/j.cali.2012.07.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2012] [Revised: 07/17/2012] [Accepted: 07/19/2012] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To describe the knowledge and perceptions of patients and health professionals on the factors that influence the quality and continuity of care of diabetic patients provided in Primary Care. MATERIAL AND METHODS A qualitative study using a phenomenological perspective. PARTICIPANTS Medical and nursing professionals working in Primary Care Centres in the city of Zaragoza, and patients with diabetes mellitus attended in the same centres. Two group (focus group) and 6 individual interviews were carried out in February and March 2010. A predetermined script, with the variables to explore, was used. RESULTS The patients and health professionals interviewed identified problems in assuming diabetes as a chronic disease. Among the factors related to success in changing habits and lifestyles, were gender (women showed greater difficulties to change), type of job and work situation. Health professionals identified the availability of guidelines and protocols, and personal motivation as factors that work in favour; and lack of time and current information systems as factors that hamper the provision of good quality care. There were discrepancies among health professionals as regards the role played by patient groups and associations. CONCLUSIONS It is important to take into account the factors that make changes in habits and lifestyles difficult, such as gender and the employment situation, when designing actions aimed at modifying risk factors in diabetic patients.
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Agudelo-Suárez AA, Ruiz-Cantero MT, González-Zapata LI, Restrepo-Medrano JC, Ortiz-Barreda GM. The parliamentary political agenda: a tool for policy analysis of diabetes priorities in Spain. GACETA SANITARIA 2012; 26:554-9. [PMID: 22560240 DOI: 10.1016/j.gaceta.2012.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2011] [Revised: 02/22/2012] [Accepted: 03/18/2012] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To analyze the political agenda on diabetes in Spain under democracy by considering the frequency and content of initiatives in the Spanish parliament. METHODS A systematic search of parliamentary interventions (1979-2010) reported on the Spanish Congress of Deputies' web page was carried out using the key word "diabetes". A descriptive study of the frequency of interventions was performed, followed by a content analysis, according to the priorities of the World Health Organization (WHO), the International Diabetes Federation and the Spanish Diabetes Federation. Other study variables were the year of presentation, legislature, type of initiative and whether a political decision was taken (yes/no). RESULTS There were 59 interventions: 22% were related to the first international initiatives and 44.1% took place in the last two legislatures in response to the WHO's program Diabetes Action Now. A total of 32.2% of the initiatives addressed educational and social programs, while 23.7% addressed access to resources and health services. Most initiatives (74.6%) consisted of parliamentary questions to the government, which only required a response. Of the 15 initiatives requiring a decision to be taken, only eight were approved. CONCLUSIONS Spanish legislators aim to comply with international standards. Nevertheless, political decision-making has sometimes been slow. Importantly, most of the political responsibilities related to health have been transferred to the autonomous regions. The updated National Diabetes Strategy in Spain will need to strengthen public health policies according to established international priorities. Monitoring parliamentary interventions has proven to be a valid tool for evaluating patterns of political debate and decisions on diabetes.
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Soriguer F, Ruiz de Adana MS. Calidad de la asistencia a los pacientes con diabetes mellitus tipo 2 en España. Med Clin (Barc) 2012; 138:522-4. [DOI: 10.1016/j.medcli.2011.09.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2011] [Accepted: 09/22/2011] [Indexed: 10/15/2022]
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Relación del grado de control glucémico con las características de la diabetes y el tratamiento de la hiperglucemia en la diabetes tipo 2. Estudio DIABES. Med Clin (Barc) 2012; 138:505-11. [DOI: 10.1016/j.medcli.2011.06.026] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2011] [Revised: 06/21/2011] [Accepted: 06/21/2011] [Indexed: 11/20/2022]
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Forst T, Pfützner A. Linagliptin, a dipeptidyl peptidase-4 inhibitor with a unique pharmacological profile, and efficacy in a broad range of patients with type 2 diabetes. Expert Opin Pharmacother 2012; 13:101-10. [PMID: 22149370 DOI: 10.1517/14656566.2012.642863] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Increasing population age, obesity and physical inactivity mean that type 2 diabetes mellitus (T2DM) is increasingly common. Current treatments may be limited by adverse events, drug-drug interactions or contraindication/need for dose adjustment in patients with renal impairment. AREAS COVERED This paper reviews studies that evaluate the pharmacokinetics, pharmacodynamics and clinical efficacy and safety of linagliptin , a dipeptidyl peptidase-4 (DPP-4) inhibitor, recently approved in the US, Japan and Europe for the treatment of T2DM. EXPERT OPINION Oral linagliptin, 5 mg once daily, is an effective, well-tolerated DPP-4 inhibitor, suitable for use in a wide range of patients with T2DM. It is weight-neutral, without increasing the risk of hypoglycemia, and can be administered either alone or in combination with other diabetes treatments. It has a unique pharmacological profile within its class and, unlike other DPP-4 inhibitors, linagliptin does not require dose adjustment in patients with renal impairment.
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Affiliation(s)
- Thomas Forst
- Institute for Clinical Research and Development, Mainz, Germany.
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Vinagre I, Mata-Cases M, Hermosilla E, Morros R, Fina F, Rosell M, Castell C, Franch-Nadal J, Bolíbar B, Mauricio D. Control of glycemia and cardiovascular risk factors in patients with type 2 diabetes in primary care in Catalonia (Spain). Diabetes Care 2012; 35:774-9. [PMID: 22344609 PMCID: PMC3308283 DOI: 10.2337/dc11-1679] [Citation(s) in RCA: 179] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2011] [Accepted: 12/27/2011] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The objective of this study was to analyze the clinical characteristics and levels of glycemic and cardiovascular risk factor control in patients with type 2 diabetes that are in primary health care centers in Catalonia (Spain). RESEARCH DESIGN AND METHODS This was a cross-sectional study of a total population of 3,755,038 individuals aged 31-90 years at the end of 2009. Clinical data were obtained retrospectively from electronic clinical records. RESULTS A total of 286,791 patients with type 2 diabetes were identified (7.6%). Fifty-four percent were men, mean (SD) age was 68.2 (11.4) years, and mean duration of disease was 6.5 (5.1) years. The mean (SD) A1C value was 7.15 (1.5)%, and 56% of the patients had A1C values ≤7%. The mean (SD) blood pressure (BP) values were 137.2 (13.8)/76.4 (8.3) mmHg, mean total cholesterol concentration was 192 (38.6) mg/dL, mean HDL cholesterol concentration was 49.3 (13.2) mg/dL, mean LDL cholesterol (LDL-C) concentration was 112.5 (32.4) mg/dL, and mean BMI was 29.6 (5) kg/m(2). Thirty-one percent of the patients had BP values ≤130/80 mmHg, 37.9% had LDL-C values ≤100 mg/dL, and 45.4% had BMI values ≤30 kg/m(2). Twenty-two percent were managed exclusively with lifestyle changes. Regarding medicated diabetic patients, 46.9, 22.9, and 2.8% were prescribed one, two, or three antidiabetic drugs, respectively, and 23.4% received insulin therapy. CONCLUSIONS The results from this study indicate a similar or improved control of glycemia, lipids, and BP in patients with type 2 diabetes when compared with previous studies performed in Spain and elsewhere.
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Affiliation(s)
- Irene Vinagre
- Department of Endocrinology and Nutrition, Diabetes Unit, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Manel Mata-Cases
- Primary Care Center La Mina, Gerencia d’Ambit d’Atencio Primaria Barcelona Ciutat, Institut Catala de la Salut, Barcelona, Spain
- Institut Universitari d’Investigacio en Atencio Primaria Jordi Gol, Barcelona, Spain
| | - Eduard Hermosilla
- Institut Universitari d’Investigacio en Atencio Primaria Jordi Gol, Barcelona, Spain
| | - Rosa Morros
- Institut Universitari d’Investigacio en Atencio Primaria Jordi Gol, Barcelona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Francesc Fina
- Institut Universitari d’Investigacio en Atencio Primaria Jordi Gol, Barcelona, Spain
- Institut Catala de la Salut, Barcelona, Spain
| | - Magdalena Rosell
- Institut Universitari d’Investigacio en Atencio Primaria Jordi Gol, Barcelona, Spain
| | - Conxa Castell
- Public Health Management Agency, Generalitat de Catalunya Health Department, Barcelona, Spain
| | - Josep Franch-Nadal
- Institut Universitari d’Investigacio en Atencio Primaria Jordi Gol, Barcelona, Spain
- Primary Care Center Raval, Gerencia d’Ambit d’Atencio Primaria Barcelona Ciutat, Institut Catala de la Salut, Barcelona, Spain
| | - Bonaventura Bolíbar
- Institut Universitari d’Investigacio en Atencio Primaria Jordi Gol, Barcelona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Didac Mauricio
- Department of Endocrinology and Nutrition, Hospital Universitari Arnau de Vilanova, Lleida, Spain
- Institut de Recerca Biomedica de Lleida, University of Lleida, Lleida, Spain
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de León AC, Coello SD, González DA, Díaz BB, Rodríguez JCDC, Hernández AG, Aguirre-Jaime A, Pérez MDCR. Impaired fasting glucose, ancestry and waist-to-height ratio: main predictors of incident diagnosed diabetes in the Canary Islands. Diabet Med 2012; 29:399-403. [PMID: 21883429 DOI: 10.1111/j.1464-5491.2011.03420.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIMS To estimate the incidence rate and risk factors for diabetes in the Canary Islands. METHODS A total of 5521 adults without diabetes were followed for a median of 3.5 years. Incident cases of diabetes were self-declared and validated in medical records. The following factors were assessed by Cox regression to estimate the hazard ratios for diabetes: impaired fasting glucose (5.6 mmol/l ≤ fasting glucose ≤ 6.9 mmol/l), BMI, waist-to-height ratio (≥ 0.55), insulin resistance (defined as triglycerides/HDL cholesterol ≥ 3), familial antecedents of diabetes, Canarian ancestry, smoking, alcohol intake, sedentary lifestyle, Mediterranean diet, social class and the metabolic syndrome. RESULTS The incidence rate was 7.5/10(3) person-years (95% CI 6.4-8.8). The greatest risks were obtained for impaired fasting glucose (hazard ratio 2.6; 95% CI 1.8-3.8), Canarian ancestry (hazard ratio 1.9; 95% CI 1.0-3.4), waist-to-height ratio (hazard ratio 1.7; 95% CI 1.1-2.5), insulin resistance (hazard ratio 1.5; 95% CI 1.0-2.2) and paternal history of diabetes (hazard ratio 1.5; 95% CI 1.0-2.3). The metabolic syndrome (hazard ratio 1.9; 95% CI 1.3-2.8) and BMI ≥ 30 kg/m(2) (hazard ratio 1.7; 95% CI 1.0-2.7) were significant only when their effects were not adjusted for impaired fasting glucose and waist-to-height ratio, respectively. CONCLUSIONS The incidence of diabetes in the Canary Islands is 1.5-fold higher than that in continental Spain and 1.7-fold higher than in the UK. The main predictors of diabetes were impaired fasting glucose, Canarian ancestry, waist-to-height ratio and insulin resistance. The metabolic syndrome predicted diabetes only when its effect was not adjusted for impaired fasting glucose. In individuals with Canarian ancestry, genetic susceptibility studies may be advisable. In order to propose preventive strategies, impaired fasting glucose, waist-to-height ratio and triglyceride/HDL cholesterol should be used to identify subjects with an increased risk of developing diabetes.
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Affiliation(s)
- A Cabrera de León
- Primary Care Research Unit and Nuestra Señora de la Candelaria University Hospital, Tenerife, Canary Islands, Spain.
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Mata-Cases M, Roura-Olmeda P, Berengué-Iglesias M, Birulés-Pons M, Mundet-Tuduri X, Franch-Nadal J, Benito-Badorrey B, Cano-Pérez JF. Fifteen years of continuous improvement of quality care of type 2 diabetes mellitus in primary care in Catalonia, Spain. Int J Clin Pract 2012; 66:289-98. [PMID: 22340449 PMCID: PMC3584513 DOI: 10.1111/j.1742-1241.2011.02872.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
AIMS To assess the evolution of type 2 diabetes mellitus (T2DM) quality indicators in primary care centers (PCC) as part of the Group for the Study of Diabetes in Primary Care (GEDAPS) Continuous Quality Improvement (GCQI) programme in Catalonia. METHODS Sequential cross-sectional studies were performed during 1993-2007. Process and outcome indicators in random samples of patients from each centre were collected. The results of each evaluation were returned to each centre to encourage the implementation of correcting interventions. Sixty-four different educational activities were performed during the study period with the participation of 2041 professionals. RESULTS Clinical records of 23,501 patients were evaluated. A significant improvement was observed in the determination of some annual process indicators: HbA(1c) (51.7% vs. 88.9%); total cholesterol (75.9% vs. 90.9%); albuminuria screening (33.9% vs. 59.4%) and foot examination (48.9% vs. 64.2%). The intermediate outcome indicators also showed significant improvements: glycemic control [HbA(1c) ≤ 7% (< 57 mmol/mol); (41.5% vs. 64.2%)]; total cholesterol [≤ 200 mg/dl (5.17 mmol/l); (25.5% vs. 65.6%)]; blood pressure [≤ 140/90 mmHg; (45.4% vs. 66.1%)]. In addition, a significant improvement in some final outcome indicators such as prevalence of foot ulcers (7.6% vs. 2.6%); amputations (1.9% vs. 0.6%) and retinopathy (18.8% vs. 8.6%) was observed. CONCLUSIONS Although those changes should not be strictly attributed to the GCQI programme, significant improvements in some process indicators, parameters of control and complications were observed in a network of primary care centres in Catalonia.
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Affiliation(s)
- M Mata-Cases
- Primary Care Center (PCC) La Mina, Sant Adrià de Besòs, Barcelona, Spain.
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Vidal Pardo JI, Pérez Castro TR, López Álvarez XL, García Soidán FJ, Santiago Pérez MI, Muñiz J. Quality of care of patients with type-2 diabetes in Galicia (NW Spain) [OBTEDIGA project]. Int J Clin Pract 2011; 65:1067-75. [PMID: 21801286 DOI: 10.1111/j.1742-1241.2011.02739.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
AIMS The aim of this study was to describe the degree of compliance of agreed practices with reference to primary care patients with Type 2 diabetes of 40 years old and older in Galicia (NW Spain). METHODS A total of 108 primary care physicians were selected at random from the totality of doctors. Each physician selected 30 patients at random from their patients suffering from diabetes of 40 years old or older. External observers gathered information from each patient's medical record regarding their characteristics, condition and degree of compliance of selected indicators of good practice. RESULTS Group of physicians participated in this study had a mean age of 50 years (standard deviation = 3.9); 48% of them were females; and 17.5% involved in medical residents training. A total of 3078 diabetic patients were included in the study: mean age = 69 years (SD = 10.9), 47.6% women, presence of high blood pressure (72%), hypercholesterolaemia (56%), and regular smokers (10.3%). Compliance with selected indicators such as foot examination (14%), ophthalmological examination (30.6%), abdominal circumference measurement (6.1%), measurement of total or LDL-cholesterol (78.1), blood pressure measurement (84.8), glycosylated haemoglobin measurement < 7% (54.3%) was observed. Adequate monitoring in cases of high blood pressure and hypercholesterolaemia were 34.2% and 27.4%, respectively. Variability between physicians differs according to the different indicators, with interquartile range for compliance of between 16.4 and 66%. CONCLUSIONS There is a wide margin for improvement in the adaptation of clinical practice to recommendations for diabetic patients. The large variation existing in certain indicators would suggest that certain control objectives are less demanding than advisable in those that comply least, while low compliance and low variability in other indicators point to structural problems or unsatisfactory training of doctors.
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Affiliation(s)
- J I Vidal Pardo
- Servicio de Endocrinoloxía, Complexo Hospitalario Lucus Augusti, Servicio Galego de Saúde, Lugo, Spain
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Criado-Álvarez JJ, Méndez-Cabeza Fuentes JC, Bustos Guadaño F. Concentración de hemoglobina glucosilada (HbA1c) en el área de Talavera de la Reina (Toledo) (2006-2008). Med Clin (Barc) 2011; 137:331-2. [DOI: 10.1016/j.medcli.2010.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2010] [Accepted: 10/26/2010] [Indexed: 10/18/2022]
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Tratamiento y control de los factores de riesgo según el riesgo coronario en la población española del estudio DARIOS. Rev Esp Cardiol 2011; 64:766-73. [DOI: 10.1016/j.recesp.2011.04.019] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2011] [Accepted: 04/29/2011] [Indexed: 12/11/2022]
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Goodall G, Costi M, Timlin L, Reviriego J, Sacristán JA, Smith-Palmer J, Dilla T. Cost-effectiveness of exenatide versus insulin glargine in Spanish patients with obesity and type 2 diabetes mellitus. ACTA ACUST UNITED AC 2011. [DOI: 10.1016/j.endoen.2011.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Goodall G, Costi M, Timlin L, Reviriego J, Sacristán JA, Smith-Palmer J, Dilla T. [Cost-effectiveness of exenatide versus insulin glargine in Spanish patients with obesity and type 2 diabetes mellitus]. ACTA ACUST UNITED AC 2011; 58:331-40. [PMID: 21719364 DOI: 10.1016/j.endonu.2011.04.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2010] [Revised: 04/12/2011] [Accepted: 04/20/2011] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND OBJECTIVES Exenatide, a GLP-1 receptor agonist for adjuvant treatment of type 2 diabetes mellitus (T2DM), has been shown to be as effective as insulin glargine (IG) for reducing glycated hemoglobin levels combined with metformin or/and sulphonylureas. Exenatide is associated to weight reduction and a higher incidence of gastrointestinal adverse events. The objective of this study was to assess the cost-effectiveness of exenatide as compared to IG in obese patients with T2DM not achieving an adequate blood glucose control from the perspective of the Spanish healthcare system. METHODS Pharmacoeconomic model inputs were obtained from an obese subpopulation (BMI ≥ 30 k/m(2)) of an international, randomized, controlled clinical trial comparing exenatide with IG in poorly controlled T2DM patients, and were supplemented with country-specific data. RESULTS Exenatide was associated to improvements in life-years gained and quality-adjusted life years (QALYs) by 0.11 and 0.62 respectively versus IG. Direct costs were € 9,306 higher as compared to IG (€ 47,010 versus € 37,704, with increased pharmacy costs as the main driver). Exenatideís incremental cost-effectiveness ratio was € 15,068 per QALY gained versus IG. CONCLUSIONS Exenatide was associated to greater clinical benefits and higher costs in obese T2DM patients as compared to IG. Considering a willingness-to-pay threshold of € 30,000 per QALY gained in the Spanish setting, exenatide represents an efficient option in comparison with IG.
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Jiménez-García R, Esteban-Hernández J, Hernández-Barrera V, Jimenez-Trujillo I, López-de-Andrés A, Carrasco Garrido P. Clustering of unhealthy lifestyle behaviors is associated with nonadherence to clinical preventive recommendations among adults with diabetes. J Diabetes Complications 2011; 25:107-13. [PMID: 20554450 DOI: 10.1016/j.jdiacomp.2010.04.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2010] [Revised: 04/08/2010] [Accepted: 04/30/2010] [Indexed: 11/17/2022]
Abstract
AIM Analyze clustering of unhealthy lifestyle behavior and its relationship with nonadherence to clinical preventive care services among Spanish diabetic adults. METHODS Cross-sectional study including 2156 diabetic adults from the 2006 Spanish National Health Survey. Subjects were asked about their uptake of BP measurement, lipid profile, influenza vaccination, and dental examination. Lifestyle behaviors included smoking status, physical activity, alcohol consumption, and dieting. Binary logistic regression models were built to assess the association between clustering of unhealthy lifestyle and the uptake of each preventive activity. RESULTS Almost 16% and 36% of the subjects had not undergone blood pressure (BP) and blood lipids measurements, respectively. Forty percent had not been vaccinated and 72% had not received dental examination. Fourteen percent of the subjects had three to four unhealthy behaviors and this increased the probability of not having BP check-up (OR 2.32, 95% CI 1.38-3.91), blood lipids testing (OR 1.63, 95% CI 1.14-2.33), and not being vaccinated (OR 1.99, 95% CI 1.37-2.89). Number of unhealthy lifestyle behaviors is linearly associated with number of preventive measures unfulfilled. CONCLUSIONS Adherence to recommended clinical preventive services is under desirable levels among Spanish diabetes sufferers. These preventive services are provided neither equitably nor efficiently, since subjects with unhealthier lifestyles are less likely to receive them.
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Affiliation(s)
- Rodrigo Jiménez-García
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcorcón 28922, Madrid, Spain
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